Provider First Line Business Practice Location Address:
803 EAST CENTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-249-7708
Provider Business Practice Location Address Fax Number:
336-249-6490
Provider Enumeration Date:
08/02/2006