Provider First Line Business Practice Location Address:
162 NC HIGHWAY 33 E
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:
27886-8582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-641-0514
Provider Business Practice Location Address Fax Number:
252-641-1688
Provider Enumeration Date:
12/01/2006