Provider First Line Business Practice Location Address:
1620 GUESS RD
Provider Second Line Business Practice Location Address:
NORTHGATE S/C
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27701-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-286-3192
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006