Provider First Line Business Practice Location Address:
117 SOUTH KING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALIFAX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27839-0446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-583-1984
Provider Business Practice Location Address Fax Number:
252-583-1615
Provider Enumeration Date:
01/23/2007