Provider First Line Business Practice Location Address:
4421 HIGHWAY 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALIFAX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-536-2511
Provider Business Practice Location Address Fax Number:
252-536-2432
Provider Enumeration Date:
05/09/2007