Provider First Line Business Practice Location Address:
105 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889-4923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-362-3142
Provider Business Practice Location Address Fax Number:
252-362-3152
Provider Enumeration Date:
01/26/2015