Provider First Line Business Practice Location Address:
152 S MOORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27330-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-708-5522
Provider Business Practice Location Address Fax Number:
919-777-5177
Provider Enumeration Date:
12/06/2010