Provider First Line Business Practice Location Address:
1890 US HWY 17 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POLLOCKSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28573-9782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-224-0112
Provider Business Practice Location Address Fax Number:
252-224-1076
Provider Enumeration Date:
10/18/2006