Provider First Line Business Practice Location Address:
180 PROVIDENCE RD
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27514-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-593-0577
Provider Business Practice Location Address Fax Number:
919-321-0394
Provider Enumeration Date:
12/22/2005