Provider First Line Business Practice Location Address:
15 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUPPLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28462-3350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-754-5437
Provider Business Practice Location Address Fax Number:
910-754-5443
Provider Enumeration Date:
10/31/2007