Provider First Line Business Practice Location Address:
154 HWY NC 42
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWELLSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27967-0218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-332-6804
Provider Business Practice Location Address Fax Number:
252-332-5199
Provider Enumeration Date:
01/22/2007