Provider First Line Business Practice Location Address:
2720 CHINQUAPIN RD
Provider Second Line Business Practice Location Address:
394 ELLIS RD
Provider Business Practice Location Address City Name:
TARBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-8546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-907-2556
Provider Business Practice Location Address Fax Number:
252-823-3083
Provider Enumeration Date:
02/19/2010