Provider First Line Business Practice Location Address:
923 W 3RD ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-9684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-775-9027
Provider Business Practice Location Address Fax Number:
910-775-9131
Provider Enumeration Date:
05/02/2008