Provider First Line Business Practice Location Address:
607B S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27021-9016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-983-0433
Provider Business Practice Location Address Fax Number:
336-983-0808
Provider Enumeration Date:
07/17/2006