Provider First Line Business Practice Location Address:
1680 E BOOKER DAIRY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-9405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-938-0081
Provider Business Practice Location Address Fax Number:
919-938-0083
Provider Enumeration Date:
10/31/2006