Provider First Line Business Practice Location Address:
3820 BRIDGES STREET
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-727-1669
Provider Business Practice Location Address Fax Number:
252-727-4977
Provider Enumeration Date:
02/13/2007