Provider First Line Business Practice Location Address:
218 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-497-8599
Provider Business Practice Location Address Fax Number:
910-436-5928
Provider Enumeration Date:
09/20/2006