Provider First Line Business Practice Location Address:
198 NC HIGHWAY 45 N
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:
27962-9232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-793-3023
Provider Business Practice Location Address Fax Number:
252-791-3159
Provider Enumeration Date:
11/10/2005