Provider First Line Business Practice Location Address:
122 W WADE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28170-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-410-0096
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007