Provider First Line Business Practice Location Address:
1514 EAST RIVER ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-496-1903
Provider Business Practice Location Address Fax Number:
919-496-1803
Provider Enumeration Date:
03/23/2007