Provider First Line Business Practice Location Address:
2535 US HIGHWAY 64 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27962-9349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-791-0489
Provider Business Practice Location Address Fax Number:
252-791-0488
Provider Enumeration Date:
12/12/2011