Provider First Line Business Practice Location Address:
1321 HUMPHREY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27701-4229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-687-6997
Provider Business Practice Location Address Fax Number:
919-687-6997
Provider Enumeration Date:
12/05/2022