Provider First Line Business Practice Location Address:
504 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27962-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-793-2209
Provider Business Practice Location Address Fax Number:
252-793-2035
Provider Enumeration Date:
02/07/2007