Provider First Line Business Practice Location Address:
660 NC HIGHWAY 42 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-553-5652
Provider Business Practice Location Address Fax Number:
919-553-4035
Provider Enumeration Date:
09/30/2019