Provider First Line Business Practice Location Address:
105 N 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-727-5279
Provider Business Practice Location Address Fax Number:
252-726-0298
Provider Enumeration Date:
09/20/2006