Provider First Line Business Practice Location Address:
401 E 3RD ST
Provider Second Line Business Practice Location Address:
UNIT 3C
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-8889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-521-1198
Provider Business Practice Location Address Fax Number:
910-521-8767
Provider Enumeration Date:
08/08/2011