Provider First Line Business Practice Location Address:
101 E CLAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEBANE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27302-2434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-304-3784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2009