Provider First Line Business Practice Location Address:
3040 JUNIOR ORDER HOME RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-956-5505
Provider Business Practice Location Address Fax Number:
336-956-5509
Provider Enumeration Date:
12/05/2013