Provider First Line Business Practice Location Address:
143 JAMES STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28586-9240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-244-0048
Provider Business Practice Location Address Fax Number:
252-244-6889
Provider Enumeration Date:
06/19/2009