Provider First Line Business Practice Location Address:
217 COURT 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:
27549-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-430-9179
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2010