Provider First Line Business Practice Location Address:
1252 S FIFTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEBANE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27302-9756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-304-3788
Provider Business Practice Location Address Fax Number:
919-304-2589
Provider Enumeration Date:
12/13/2005