Provider First Line Business Practice Location Address:
201 LUMBERTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAROLINA BEACH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28428-4846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-543-3558
Provider Business Practice Location Address Fax Number:
910-400-2095
Provider Enumeration Date:
10/28/2020