Provider First Line Business Practice Location Address:
828 ACADEMY ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AHOSKIE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27910-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-862-4054
Provider Business Practice Location Address Fax Number:
252-862-4263
Provider Enumeration Date:
12/21/2006