Provider First Line Business Practice Location Address:
108 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27849-9690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-348-4000
Provider Business Practice Location Address Fax Number:
252-348-4001
Provider Enumeration Date:
07/01/2005