Provider First Line Business Practice Location Address: 
111 HOSPITAL DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TARBORO
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
27886-2011
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
252-641-7700
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/04/2006