Provider First Line Business Practice Location Address:
103 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
CARRBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27510-2072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-968-6682
Provider Business Practice Location Address Fax Number:
919-968-1764
Provider Enumeration Date:
12/18/2006