Provider First Line Business Practice Location Address:
11491 US HIGHWAY 70 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-550-2484
Provider Business Practice Location Address Fax Number:
919-550-7059
Provider Enumeration Date:
07/17/2006