Provider First Line Business Practice Location Address:
134B LIBERTY SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349-8602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-296-0500
Provider Business Practice Location Address Fax Number:
910-296-0515
Provider Enumeration Date:
03/02/2026