Provider First Line Business Practice Location Address:
1294 PRIDDY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27021-7485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-983-3068
Provider Business Practice Location Address Fax Number:
336-983-0681
Provider Enumeration Date:
03/08/2007