Provider First Line Business Practice Location Address:
112 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466-1665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-7388
Provider Business Practice Location Address Fax Number:
910-285-9149
Provider Enumeration Date:
01/26/2006