Provider First Line Business Practice Location Address:
211 DRUMMER KELLUM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546-9308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-355-2000
Provider Business Practice Location Address Fax Number:
910-355-6900
Provider Enumeration Date:
02/28/2007