Provider First Line Business Practice Location Address:
11337 JOE BROWN HWY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TABOR CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28463-8597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-653-5050
Provider Business Practice Location Address Fax Number:
910-653-6123
Provider Enumeration Date:
12/12/2006