Provider First Line Business Practice Location Address:
220 E 1ST AVENUE EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27292-3368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-635-2080
Provider Business Practice Location Address Fax Number:
704-636-2089
Provider Enumeration Date:
06/27/2013