Provider First Line Business Practice Location Address:
215 S BICKETT BLVD
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:
27549-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-497-4500
Provider Business Practice Location Address Fax Number:
919-497-5407
Provider Enumeration Date:
12/20/2006