Provider First Line Business Practice Location Address:
13741 NC HIGHWAY 50 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SURF CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28445-6935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-777-2732
Provider Business Practice Location Address Fax Number:
910-777-2742
Provider Enumeration Date:
09/17/2009