Provider First Line Business Practice Location Address:
57635 N. HIGHWAY 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATTARAS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27943-0400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-986-2756
Provider Business Practice Location Address Fax Number:
252-986-0126
Provider Enumeration Date:
12/20/2005