Provider First Line Business Practice Location Address:
554 HWY 306 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28529-5989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-745-7303
Provider Business Practice Location Address Fax Number:
252-745-4743
Provider Enumeration Date:
06/19/2009