Provider First Line Business Practice Location Address:
500 E KU SU MEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANDOR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27229-9058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-974-4183
Provider Business Practice Location Address Fax Number:
910-974-7310
Provider Enumeration Date:
07/28/2022