Provider First Line Business Practice Location Address:
339 S MAIN ST
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:
27356-7765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-428-4422
Provider Business Practice Location Address Fax Number:
910-428-4220
Provider Enumeration Date:
09/22/2015