Provider First Line Business Practice Location Address:
948 N MAIN ST
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:
27549-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-496-3375
Provider Business Practice Location Address Fax Number:
919-496-5669
Provider Enumeration Date:
04/04/2006