Provider First Line Business Practice Location Address:
101 E 1ST AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27292-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-248-8154
Provider Business Practice Location Address Fax Number:
336-248-8155
Provider Enumeration Date:
10/18/2006