Provider First Line Business Practice Location Address:
1913 LAMAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-286-1509
Provider Business Practice Location Address Fax Number:
919-416-3768
Provider Enumeration Date:
05/15/2007