Provider First Line Business Practice Location Address:
2129 S GLENBURNIE RD
Provider Second Line Business Practice Location Address:
SUITE 12 SOUTH MARKET SQUARE
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-5267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-672-0253
Provider Business Practice Location Address Fax Number:
252-514-0180
Provider Enumeration Date:
01/06/2014