Provider First Line Business Practice Location Address:
130 NE CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT OLIVE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28365-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-658-2505
Provider Business Practice Location Address Fax Number:
919-658-0549
Provider Enumeration Date:
03/21/2007