Provider First Line Business Practice Location Address:
1295 OLD US #1 S
Provider Second Line Business Practice Location Address:
STE F
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-246-2099
Provider Business Practice Location Address Fax Number:
910-692-5016
Provider Enumeration Date:
12/13/2005