Provider First Line Business Practice Location Address:
501 S POPLAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28337-9375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-862-5179
Provider Business Practice Location Address Fax Number:
910-862-5129
Provider Enumeration Date:
05/05/2008