Provider First Line Business Practice Location Address:
401 PROVIDENCE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-929-7155
Provider Business Practice Location Address Fax Number:
919-929-7155
Provider Enumeration Date:
12/28/2006