Provider First Line Business Practice Location Address:
203 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28390-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-339-9375
Provider Business Practice Location Address Fax Number:
910-491-0077
Provider Enumeration Date:
05/31/2012