Provider First Line Business Practice Location Address:
5625 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:
28466-6095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-3411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2006