Provider First Line Business Practice Location Address:
112 BARBOUR ST
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:
27520-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-879-8216
Provider Business Practice Location Address Fax Number:
919-879-8479
Provider Enumeration Date:
10/24/2006