Provider First Line Business Practice Location Address:
2208 JAMES B WHITE HWY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-8964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-640-1153
Provider Business Practice Location Address Fax Number:
910-642-4085
Provider Enumeration Date:
06/26/2013