Provider First Line Business Practice Location Address:
105 EAST CHURCH STREET
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:
27886-0187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-823-8135
Provider Business Practice Location Address Fax Number:
252-823-2455
Provider Enumeration Date:
11/03/2006