Provider First Line Business Practice Location Address:
1022 US HWY 64 E
Provider Second Line Business Practice Location Address:
BLDG # 4
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27962-9215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-793-5073
Provider Business Practice Location Address Fax Number:
252-793-3278
Provider Enumeration Date:
03/18/2008