Provider First Line Business Practice Location Address:
1213 DAWKINS STREET
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-381-4431
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2026