Provider First Line Business Practice Location Address:
5383 US 117 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27863-0335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-242-6369
Provider Business Practice Location Address Fax Number:
919-242-9884
Provider Enumeration Date:
06/20/2007