Provider First Line Business Practice Location Address:
108 S WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-796-1371
Provider Business Practice Location Address Fax Number:
252-796-1188
Provider Enumeration Date:
06/14/2006