Provider First Line Business Practice Location Address:
1683B US 401 HWY SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27549-6829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-496-5827
Provider Business Practice Location Address Fax Number:
919-496-6452
Provider Enumeration Date:
01/29/2007