Provider First Line Business Practice Location Address:
3006 LASSITER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLY SPRINGS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27540-3374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-247-2649
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2026