Provider First Line Business Practice Location Address:
100 BRYAN CHALK LN
Provider Second Line Business Practice Location Address:
KNIGHTDALE HIGH SCHOOL
Provider Business Practice Location Address City Name:
KNIGHTDALE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27545-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-217-5350
Provider Business Practice Location Address Fax Number:
919-217-5356
Provider Enumeration Date:
03/24/2014