Provider First Line Business Practice Location Address:
1301 W. FIRST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILL DEVIL HILLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-260-8816
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2007