Provider First Line Business Practice Location Address:
121 B S. 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. PAULS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28384-1573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
190-865-8280
Provider Business Practice Location Address Fax Number:
190-865-8281
Provider Enumeration Date:
02/14/2007