Provider First Line Business Practice Location Address:
567 US HIGHWAY 64 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27962-2144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-791-3033
Provider Business Practice Location Address Fax Number:
252-791-3031
Provider Enumeration Date:
12/04/2006