Provider First Line Business Practice Location Address:
1107 S FIFTH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MEBANE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27302-9597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-563-4111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2009