Provider First Line Business Practice Location Address:
201 E MAIN ST
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:
27520-2449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-553-4111
Provider Business Practice Location Address Fax Number:
919-553-2845
Provider Enumeration Date:
06/27/2005