Provider First Line Business Practice Location Address:
113 JUSTICE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27549-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-853-2700
Provider Business Practice Location Address Fax Number:
919-853-7527
Provider Enumeration Date:
11/30/2007