Provider First Line Business Practice Location Address:
9 WEST THIRD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27292-3458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-224-0863
Provider Business Practice Location Address Fax Number:
336-238-1013
Provider Enumeration Date:
07/27/2006