Provider First Line Business Practice Location Address:
121 E WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27962-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-791-0093
Provider Business Practice Location Address Fax Number:
252-791-0939
Provider Enumeration Date:
07/08/2008