Provider First Line Business Practice Location Address:
199 WEST WASHINGTON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27812-9497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-825-0480
Provider Business Practice Location Address Fax Number:
252-825-1955
Provider Enumeration Date:
06/19/2009