Provider First Line Business Practice Location Address:
210 N. ROAD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27925-0328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-796-1121
Provider Business Practice Location Address Fax Number:
252-796-1492
Provider Enumeration Date:
02/02/2007