Provider First Line Business Practice Location Address:
CLARK CLINIC
Provider Second Line Business Practice Location Address:
BLDG 5-4257
Provider Business Practice Location Address City Name:
FORT LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
38310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-907-2575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2014