Provider First Line Business Practice Location Address:
601 EAST 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-946-4113
Provider Business Practice Location Address Fax Number:
252-946-9552
Provider Enumeration Date:
08/09/2006