Provider First Line Business Practice Location Address:
1027 EAST US HWY 74 BUS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-453-1730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2010