Provider First Line Business Practice Location Address:
211 PROVIDENCE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-423-8649
Provider Business Practice Location Address Fax Number:
919-490-4845
Provider Enumeration Date:
06/12/2007