Provider First Line Business Practice Location Address:
2100 STANTONSBURG ROAD
Provider Second Line Business Practice Location Address:
1 SOUTH ENT/ UROLOGY OFFICE
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-847-2619
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2006