Provider First Line Business Practice Location Address:
303 E 3RD 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:
28372-7991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-521-7518
Provider Business Practice Location Address Fax Number:
910-521-7520
Provider Enumeration Date:
03/01/2007