Provider First Line Business Practice Location Address:
113 E SOTHEL ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
KILL DEVIL HILLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27948-6961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-207-3701
Provider Business Practice Location Address Fax Number:
252-441-3057
Provider Enumeration Date:
03/19/2007