Provider First Line Business Practice Location Address:
26772 HWY 264 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANTEGO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27860-0238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-943-3779
Provider Business Practice Location Address Fax Number:
252-943-3779
Provider Enumeration Date:
01/19/2007