Provider First Line Business Practice Location Address:
123 E MARTIN ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WADESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28170-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-694-9470
Provider Business Practice Location Address Fax Number:
704-694-2734
Provider Enumeration Date:
07/10/2007