Provider First Line Business Practice Location Address:
CLARK HEALTH CLINIC WOMACK 5-4257 BASTONGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28310-9098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-907-2575
Provider Business Practice Location Address Fax Number:
910-907-9606
Provider Enumeration Date:
09/10/2017