Provider First Line Business Practice Location Address:
808 E 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TABOR CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28463-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-653-3562
Provider Business Practice Location Address Fax Number:
910-653-9782
Provider Enumeration Date:
08/30/2006