Provider First Line Business Practice Location Address:
3820A BRIDGES 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:
28557-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-728-8550
Provider Business Practice Location Address Fax Number:
252-222-7739
Provider Enumeration Date:
01/19/2007