Provider First Line Business Practice Location Address:
107 E DUNHAM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28337-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-862-2122
Provider Business Practice Location Address Fax Number:
910-862-1279
Provider Enumeration Date:
03/22/2013