Provider First Line Business Practice Location Address:
7483 US HIGHWAY 264 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889-9282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-940-4442
Provider Business Practice Location Address Fax Number:
252-940-4443
Provider Enumeration Date:
10/10/2005