Provider First Line Business Practice Location Address:
69 CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-926-3731
Provider Business Practice Location Address Fax Number:
252-926-3213
Provider Enumeration Date:
03/06/2007