Provider First Line Business Practice Location Address:
103 W 2ND ST.
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:
27542-0235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-284-2010
Provider Business Practice Location Address Fax Number:
919-284-2231
Provider Enumeration Date:
11/01/2006