Provider First Line Business Practice Location Address:
8146 NC 56 HWY
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:
27549-6711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-496-5005
Provider Business Practice Location Address Fax Number:
919-496-0198
Provider Enumeration Date:
07/15/2006