Provider First Line Business Practice Location Address:
1555 LAKE RD HWY 56
Provider Second Line Business Practice Location Address:
SUITE 5-B
Provider Business Practice Location Address City Name:
CREEDMOOR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-528-3781
Provider Business Practice Location Address Fax Number:
919-528-0000
Provider Enumeration Date:
10/23/2006