Provider First Line Business Practice Location Address:
2076 NC HIGHWAY 42 W
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520-9226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-359-0322
Provider Business Practice Location Address Fax Number:
919-359-0326
Provider Enumeration Date:
07/12/2005