Provider First Line Business Practice Location Address:
1013 CARTHAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27330-4114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-775-8183
Provider Business Practice Location Address Fax Number:
919-775-8152
Provider Enumeration Date:
07/21/2005