Provider First Line Business Practice Location Address:
301 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28551-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-566-9595
Provider Business Practice Location Address Fax Number:
252-566-0336
Provider Enumeration Date:
09/30/2006