Provider First Line Business Practice Location Address:
SUITE 812 A VERNON PARK MALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-522-1333
Provider Business Practice Location Address Fax Number:
252-527-9321
Provider Enumeration Date:
11/16/2006