Provider First Line Business Practice Location Address:
201 CLINIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-824-1419
Provider Business Practice Location Address Fax Number:
252-823-3164
Provider Enumeration Date:
11/20/2009