Provider First Line Business Practice Location Address:
210 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANDOR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27229-8088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-974-7555
Provider Business Practice Location Address Fax Number:
910-974-4555
Provider Enumeration Date:
11/08/2012