Provider First Line Business Practice Location Address:
1121 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28401-7304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-763-8134
Provider Business Practice Location Address Fax Number:
910-763-3311
Provider Enumeration Date:
12/04/2006