Provider First Line Business Practice Location Address:
11179 HWY 55
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:
28529-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-745-7440
Provider Business Practice Location Address Fax Number:
252-745-7422
Provider Enumeration Date:
06/11/2020