Provider First Line Business Practice Location Address:
7118 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28395-9749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-483-6694
Provider Business Practice Location Address Fax Number:
910-483-2215
Provider Enumeration Date:
01/27/2006