Provider First Line Business Practice Location Address:
103 EAST HILL STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-296-0065
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2007