Provider First Line Business Practice Location Address:
1302 W MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-3339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-989-1786
Provider Business Practice Location Address Fax Number:
919-989-1791
Provider Enumeration Date:
10/16/2006