Provider First Line Business Practice Location Address:
532 A CARATOKE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOYOCK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-232-0278
Provider Business Practice Location Address Fax Number:
252-435-4063
Provider Enumeration Date:
09/20/2006