Provider First Line Business Practice Location Address:
130 EAST 2ND ST. SUITE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-947-6801
Provider Business Practice Location Address Fax Number:
910-442-8447
Provider Enumeration Date:
03/04/2026