Provider First Line Business Practice Location Address:
11560 NC 55 HWY STE 7
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:
28529-9447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-242-0088
Provider Business Practice Location Address Fax Number:
252-631-0340
Provider Enumeration Date:
06/29/2020