Provider First Line Business Practice Location Address:
11708 HWY 70 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-550-2770
Provider Business Practice Location Address Fax Number:
919-553-7926
Provider Enumeration Date:
12/26/2006