Provider First Line Business Practice Location Address:
206 E 3RD ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-7446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-280-8945
Provider Business Practice Location Address Fax Number:
910-280-8945
Provider Enumeration Date:
08/25/2026