Provider First Line Business Practice Location Address:
2740 SWAMP FOX HWY W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TABOR CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28463-8511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-840-4654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2026