Provider First Line Business Practice Location Address:
106 W CHURCH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CREEDMOOR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27522-9765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-528-4900
Provider Business Practice Location Address Fax Number:
919-528-1234
Provider Enumeration Date:
06/30/2009