Provider First Line Business Practice Location Address:
209 NO 35TH ST
Provider Second Line Business Practice Location Address:
SUITE 1 & 5
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-728-2338
Provider Business Practice Location Address Fax Number:
252-514-2770
Provider Enumeration Date:
04/18/2007