Provider First Line Business Practice Location Address:
4600 W LAKE RD
Provider Second Line Business Practice Location Address:
WEST LAKE MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27539-7657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-662-2918
Provider Business Practice Location Address Fax Number:
919-662-2906
Provider Enumeration Date:
08/31/2006