Provider First Line Business Practice Location Address:
138 N FORK NEW RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28643-9130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-982-2158
Provider Business Practice Location Address Fax Number:
336-982-3373
Provider Enumeration Date:
06/26/2007