Provider First Line Business Practice Location Address:
110 S QUEEN ST
Provider Second Line Business Practice Location Address:
110 SOUTH QUEEN STREET SUITE 118
Provider Business Practice Location Address City Name:
KINSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28501-4975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-208-1928
Provider Business Practice Location Address Fax Number:
252-559-2055
Provider Enumeration Date:
07/07/2005