Provider First Line Business Practice Location Address:
122 S HARVEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889-5033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-833-4047
Provider Business Practice Location Address Fax Number:
252-833-4048
Provider Enumeration Date:
12/08/2011