Provider First Line Business Practice Location Address:
101 E 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-284-4025
Provider Business Practice Location Address Fax Number:
919-284-5965
Provider Enumeration Date:
04/04/2006