Provider First Line Business Practice Location Address:
741 NC 24 50 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349-8954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-236-0554
Provider Business Practice Location Address Fax Number:
910-293-9370
Provider Enumeration Date:
01/16/2007