Provider First Line Business Practice Location Address:
302 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349-9019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-916-3929
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007