Provider First Line Business Practice Location Address:
305 EAST THIRD STREET
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28737-8372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-843-5021
Provider Business Practice Location Address Fax Number:
910-843-5021
Provider Enumeration Date:
05/28/2008