Provider First Line Business Practice Location Address:
522 S NORWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-7800
Provider Business Practice Location Address Fax Number:
910-285-6097
Provider Enumeration Date:
06/21/2006