Provider First Line Business Practice Location Address:
190 E CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLERBE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28338-9657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-652-3277
Provider Business Practice Location Address Fax Number:
910-652-5277
Provider Enumeration Date:
06/19/2009