Provider First Line Business Practice Location Address:
208-B S RUTHERFORD 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:
28170-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-694-0186
Provider Business Practice Location Address Fax Number:
704-694-0185
Provider Enumeration Date:
11/15/2006