Provider First Line Business Practice Location Address:
1116 WILSON STREET EXT
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:
27962-9200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-793-6440
Provider Business Practice Location Address Fax Number:
252-974-1211
Provider Enumeration Date:
01/23/2007