Provider First Line Business Practice Location Address:
101 NEVILLE ST
Provider Second Line Business Practice Location Address:
POB 13
Provider Business Practice Location Address City Name:
PRINCEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-5327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-823-7176
Provider Business Practice Location Address Fax Number:
252-823-6244
Provider Enumeration Date:
04/02/2009