Provider First Line Business Practice Location Address:
215 N 35TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-247-0094
Provider Business Practice Location Address Fax Number:
252-247-9285
Provider Enumeration Date:
11/20/2006