Provider First Line Business Practice Location Address:
223 INGRAM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27021-8206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-985-0871
Provider Business Practice Location Address Fax Number:
336-985-0871
Provider Enumeration Date:
02/20/2007