Provider First Line Business Practice Location Address:
849 NC HIGHWAY 45 N
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:
27962-9640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-809-3631
Provider Business Practice Location Address Fax Number:
252-793-3117
Provider Enumeration Date:
03/28/2012