Provider First Line Business Practice Location Address:
130 WEST WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-825-3212
Provider Business Practice Location Address Fax Number:
252-825-3213
Provider Enumeration Date:
07/17/2008