Provider First Line Business Practice Location Address:
3877 JAMES STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27812-0936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-825-1131
Provider Business Practice Location Address Fax Number:
252-825-0220
Provider Enumeration Date:
03/24/2008