Provider First Line Business Practice Location Address:
804 N MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889-4452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-946-3219
Provider Business Practice Location Address Fax Number:
252-948-1477
Provider Enumeration Date:
06/30/2008