Provider First Line Business Practice Location Address:
1034 BRAGG ST MSC 4287
Provider Second Line Business Practice Location Address:
NC CORRECTIONAL INST FOR WOMEN
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27610-3846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-733-4340
Provider Business Practice Location Address Fax Number:
919-715-4335
Provider Enumeration Date:
11/02/2006