Provider First Line Business Practice Location Address:
145 MARGINAL ST.
Provider Second Line Business Practice Location Address:
COOLEEMEE SHOPPING CENTER
Provider Business Practice Location Address City Name:
COOLEEMEE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27014-0959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-284-2595
Provider Business Practice Location Address Fax Number:
336-284-2596
Provider Enumeration Date:
04/09/2007