Provider First Line Business Practice Location Address:
1219 EMMAUS CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUDLEY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28333-6225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-735-1410
Provider Business Practice Location Address Fax Number:
919-658-8037
Provider Enumeration Date:
02/27/2007