Provider First Line Business Practice Location Address:
6656 S NC HWY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28722-8615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-247-4856
Provider Business Practice Location Address Fax Number:
828-247-4857
Provider Enumeration Date:
09/19/2007