Provider First Line Business Practice Location Address:
143 MARGINAL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOLEEMEE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27014-0910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-284-2331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2008