Provider First Line Business Practice Location Address:
128 OKEEWEMEE STAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27356-7343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-428-1111
Provider Business Practice Location Address Fax Number:
910-428-2506
Provider Enumeration Date:
06/10/2005