Provider First Line Business Practice Location Address:
14871 NC HIGHWAY 87 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAR HEEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28392-0420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-862-4314
Provider Business Practice Location Address Fax Number:
910-862-4314
Provider Enumeration Date:
07/03/2006