Provider First Line Business Practice Location Address:
501 N SALEM ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27502-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-355-5123
Provider Business Practice Location Address Fax Number:
919-650-4750
Provider Enumeration Date:
02/25/2014