Provider First Line Business Practice Location Address:
2005 N MAIN ST # T
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TARBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-824-3003
Provider Business Practice Location Address Fax Number:
252-824-3004
Provider Enumeration Date:
10/03/2006