Provider First Line Business Practice Location Address:
104 EAST SECOND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27542-0147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-284-4106
Provider Business Practice Location Address Fax Number:
919-284-2717
Provider Enumeration Date:
06/03/2008