Provider First Line Business Practice Location Address:
1300 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-575-2132
Provider Business Practice Location Address Fax Number:
919-575-2139
Provider Enumeration Date:
10/03/2006