Provider First Line Business Practice Location Address:
1242- C SOUTH FIFTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEBANE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-563-3007
Provider Business Practice Location Address Fax Number:
919-563-1993
Provider Enumeration Date:
10/31/2007