Provider First Line Business Practice Location Address: 
600 SUNSET AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CLINTON
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
28328-3946
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
910-299-0700
    Provider Business Practice Location Address Fax Number: 
910-299-0800
    Provider Enumeration Date: 
04/01/2008