Provider First Line Business Practice Location Address:
1009 NC HIGHWAY 150 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27358-9074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
366-644-2770
Provider Business Practice Location Address Fax Number:
366-644-2778
Provider Enumeration Date:
08/20/2012