Provider First Line Business Practice Location Address:
11326 NC 55 HWY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28529-9451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-745-6337
Provider Business Practice Location Address Fax Number:
252-745-5576
Provider Enumeration Date:
10/14/2010