Provider First Line Business Practice Location Address: 
300 W TRYON ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HILLSBOROUGH
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
27278-2438
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
919-245-2400
    Provider Business Practice Location Address Fax Number: 
919-644-3007
    Provider Enumeration Date: 
01/08/2014