Provider First Line Business Practice Location Address:
105 EAST BALTIMORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEBLUFF
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28373-0008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-479-8217
Provider Business Practice Location Address Fax Number:
910-281-3239
Provider Enumeration Date:
09/29/2008