Provider First Line Business Practice Location Address:
9933 HWY 70 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-585-2069
Provider Business Practice Location Address Fax Number:
919-585-2075
Provider Enumeration Date:
07/10/2012