Provider First Line Business Practice Location Address:
1 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BENSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27504-1177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-894-1057
Provider Business Practice Location Address Fax Number:
919-894-1152
Provider Enumeration Date:
10/26/2011