Provider First Line Business Practice Location Address:
703 N BROAD STREET
Provider Second Line Business Practice Location Address:
DREAM PROVIDER CARE SERVICES
Provider Business Practice Location Address City Name:
EDENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27932-0703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-946-0585
Provider Business Practice Location Address Fax Number:
252-946-0580
Provider Enumeration Date:
08/22/2011