Provider First Line Business Practice Location Address:
2131 S 17TH ST
Provider Second Line Business Practice Location Address:
COASTAL AHEC
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28401-7407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-343-0161
Provider Business Practice Location Address Fax Number:
910-762-9203
Provider Enumeration Date:
02/16/2007