Provider First Line Business Practice Location Address:
25 UNION SCHOOL RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN ISLE BEACH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28469-7307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-642-5832
Provider Business Practice Location Address Fax Number:
910-642-8814
Provider Enumeration Date:
10/05/2006