Provider First Line Business Practice Location Address:
NORTH CAROLINA DEPARTMENT OF CORRECTIONS; 4287 BRAGG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27699-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-733-4340
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2007