Provider First Line Business Practice Location Address:
1223 CARTHAGE ST
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:
27330-8984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-776-7549
Provider Business Practice Location Address Fax Number:
919-774-3330
Provider Enumeration Date:
01/24/2007