Provider First Line Business Practice Location Address:
239 S MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED SPRINGS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28377-0231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-843-4262
Provider Business Practice Location Address Fax Number:
910-843-1238
Provider Enumeration Date:
02/19/2008