Provider First Line Business Practice Location Address:
5717 S NC 41 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466-9220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-6481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2010