Provider First Line Business Practice Location Address:
363 HIGHWAY 64 WEST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-793-5942
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2006