Provider First Line Business Practice Location Address:
111 S. CHURCH STREET
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:
27549-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-250-2923
Provider Business Practice Location Address Fax Number:
919-573-4734
Provider Enumeration Date:
07/09/2008