Provider First Line Business Practice Location Address:
302 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUCAMA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27851-0012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-239-0212
Provider Business Practice Location Address Fax Number:
252-239-0312
Provider Enumeration Date:
03/30/2007