Provider First Line Business Practice Location Address:
1 OCEAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHERN SHORES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27949-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-261-3100
Provider Business Practice Location Address Fax Number:
252-261-3240
Provider Enumeration Date:
06/23/2006