Provider First Line Business Practice Location Address:
133 LIMESTONE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349-9019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-441-3045
Provider Business Practice Location Address Fax Number:
910-441-3063
Provider Enumeration Date:
03/22/2006