Provider First Line Business Practice Location Address:
1406 WESTERN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-4152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-824-7700
Provider Business Practice Location Address Fax Number:
252-824-7799
Provider Enumeration Date:
12/19/2005