Provider First Line Business Practice Location Address:
185 YOUNTZ RD
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:
27292-0666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-249-7057
Provider Business Practice Location Address Fax Number:
336-249-9984
Provider Enumeration Date:
10/03/2005