Provider First Line Business Practice Location Address:
105 EAST CENTER STREET
Provider Second Line Business Practice Location Address:
SUITE B-11
Provider Business Practice Location Address City Name:
MEBANE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27302-9725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-239-5133
Provider Business Practice Location Address Fax Number:
704-972-9749
Provider Enumeration Date:
04/19/2012