Provider First Line Business Practice Location Address:
4546 HWY 87 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27332-0212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-499-5151
Provider Business Practice Location Address Fax Number:
919-499-5147
Provider Enumeration Date:
08/16/2007