Provider First Line Business Practice Location Address:
103 E CENTER ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
MEBANE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27302-2431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-304-9561
Provider Business Practice Location Address Fax Number:
919-304-9562
Provider Enumeration Date:
06/12/2006