Provider First Line Business Practice Location Address:
255 SHINGLE LANDING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOYOCK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27958-8796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-435-6521
Provider Business Practice Location Address Fax Number:
252-435-6351
Provider Enumeration Date:
03/09/2026