Provider First Line Business Practice Location Address:
101 CLINIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-823-2105
Provider Business Practice Location Address Fax Number:
252-824-0389
Provider Enumeration Date:
11/02/2007