Provider First Line Business Practice Location Address:
203 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28390-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-497-2969
Provider Business Practice Location Address Fax Number:
910-497-6505
Provider Enumeration Date:
02/25/2008