Provider First Line Business Practice Location Address:
16 STANLEY ST
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:
28372-8540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-827-1169
Provider Business Practice Location Address Fax Number:
910-593-3577
Provider Enumeration Date:
12/16/2006