Provider First Line Business Practice Location Address:
215 W US HIGHWAY 64
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27295-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-243-5433
Provider Business Practice Location Address Fax Number:
336-243-5435
Provider Enumeration Date:
07/26/2006