Provider First Line Business Practice Location Address:
257 HOSPITAL DRIVE SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLIVIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28422-8411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-721-4000
Provider Business Practice Location Address Fax Number:
910-721-4001
Provider Enumeration Date:
12/20/2005