Provider First Line Business Practice Location Address:
143 JAMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28586-9240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-916-8310
Provider Business Practice Location Address Fax Number:
252-417-7985
Provider Enumeration Date:
10/23/2025