Provider First Line Business Practice Location Address:
90 E.F. COTTRELL RD
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:
27549-8664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-496-9926
Provider Business Practice Location Address Fax Number:
919-496-2375
Provider Enumeration Date:
12/21/2006