Provider First Line Business Practice Location Address:
100 NEVILLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-5328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-823-7175
Provider Business Practice Location Address Fax Number:
252-823-6244
Provider Enumeration Date:
01/17/2011