Provider First Line Business Practice Location Address:
2900 N MAIN ST
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:
27886-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-823-5655
Provider Business Practice Location Address Fax Number:
252-823-0412
Provider Enumeration Date:
09/21/2006