Provider First Line Business Practice Location Address:
1437 EAST RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27549-8584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-496-4170
Provider Business Practice Location Address Fax Number:
919-496-5639
Provider Enumeration Date:
04/14/2007