Provider First Line Business Practice Location Address:
112 W SAINT JOHN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-4317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-823-3864
Provider Business Practice Location Address Fax Number:
252-823-5864
Provider Enumeration Date:
07/29/2008