Provider First Line Business Practice Location Address:
601 N 8TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-360-4142
Provider Business Practice Location Address Fax Number:
252-565-0301
Provider Enumeration Date:
02/28/2014