Provider First Line Business Practice Location Address:
103 WEST CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON WOODVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-348-2658
Provider Business Practice Location Address Fax Number:
252-348-2608
Provider Enumeration Date:
07/07/2005