Provider First Line Business Practice Location Address:
320 E KING ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27021-9162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-918-7476
Provider Business Practice Location Address Fax Number:
336-983-4915
Provider Enumeration Date:
07/10/2006