Provider First Line Business Practice Location Address:
152 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27812-9312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-825-3801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2026