Provider First Line Business Practice Location Address:
1006 BROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORIENTAL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-249-1869
Provider Business Practice Location Address Fax Number:
252-249-0112
Provider Enumeration Date:
01/05/2015