Provider First Line Business Practice Location Address:
102 N MAIN ST.
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-296-0019
Provider Business Practice Location Address Fax Number:
910-226-2026
Provider Enumeration Date:
11/05/2012