Provider First Line Business Practice Location Address:
124 NORTH QUEEN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28501-4928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-527-1166
Provider Business Practice Location Address Fax Number:
252-527-3240
Provider Enumeration Date:
07/28/2010