Provider First Line Business Practice Location Address:
131 HUNTINGTON PL
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:
27549-7435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-496-2142
Provider Business Practice Location Address Fax Number:
919-496-6098
Provider Enumeration Date:
04/12/2007