Provider First Line Business Practice Location Address:
224 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28390-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-436-0424
Provider Business Practice Location Address Fax Number:
910-436-0361
Provider Enumeration Date:
06/19/2006