Provider First Line Business Practice Location Address:
2172B HWY 70A EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE LEVEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-965-0340
Provider Business Practice Location Address Fax Number:
919-965-0340
Provider Enumeration Date:
06/27/2007