Provider First Line Business Practice Location Address:
118 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-7016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-556-4888
Provider Business Practice Location Address Fax Number:
910-498-1002
Provider Enumeration Date:
10/15/2014