Provider First Line Business Practice Location Address:
6608 HIGHWAY 210 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRELLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28444-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-337-1611
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2012