Provider First Line Business Practice Location Address:
504 DEXTER ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-6320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-439-1117
Provider Business Practice Location Address Fax Number:
252-439-1119
Provider Enumeration Date:
04/13/2011