Provider First Line Business Practice Location Address:
1052 NE RAILROAD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-7881
Provider Business Practice Location Address Fax Number:
910-285-3525
Provider Enumeration Date:
04/23/2007