Provider First Line Business Practice Location Address:
122 E MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELM CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27822-0427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-399-8657
Provider Business Practice Location Address Fax Number:
252-399-8829
Provider Enumeration Date:
06/08/2007