Provider First Line Business Practice Location Address:
922 NC HIGHWAY 42 W
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:
27520-7434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-241-7734
Provider Business Practice Location Address Fax Number:
919-879-8625
Provider Enumeration Date:
11/02/2005