Provider First Line Business Practice Location Address:
308 LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-642-6001
Provider Business Practice Location Address Fax Number:
910-642-9799
Provider Enumeration Date:
06/26/2006