Provider First Line Business Practice Location Address:
604 E. 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:
27889-3405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-975-8330
Provider Business Practice Location Address Fax Number:
252-948-4801
Provider Enumeration Date:
08/30/2005