Provider First Line Business Practice Location Address:
4011 NC 56 HWY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27549-9499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-853-2347
Provider Business Practice Location Address Fax Number:
919-853-6759
Provider Enumeration Date:
09/23/2013