Provider First Line Business Practice Location Address:
10691 NC HIGHWAY 210 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28390-8049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-497-8599
Provider Business Practice Location Address Fax Number:
910-436-5928
Provider Enumeration Date:
09/26/2006