Provider First Line Business Practice Location Address:
105 W MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HOPE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-578-9213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2010