Provider First Line Business Practice Location Address:
1680 BOOKER DAIRY RD
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:
27577-9405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-938-1190
Provider Business Practice Location Address Fax Number:
919-938-1192
Provider Enumeration Date:
03/25/2009