Provider First Line Business Practice Location Address:
2744 SOUTH 17TH ST.
Provider Second Line Business Practice Location Address:
PACIFICA WILMINGTON
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-452-1114
Provider Business Practice Location Address Fax Number:
530-222-6725
Provider Enumeration Date:
01/25/2007