Individual
TERRY LEWIS PETTUS I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1515 OXLEYMARE DR, RALEIGH, NC 27610-6608
(984) 444-8943
Mailing address
1515 OXLEYMARE DR, RALEIGH, NC 27610-6608
(984) 444-8943
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
7890422
NC
Other
Enumeration date
07/29/2018
Last updated
07/29/2018
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