Provider First Line Business Practice Location Address:
145 DAIRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520-4965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-553-6144
Provider Business Practice Location Address Fax Number:
919-553-8714
Provider Enumeration Date:
08/20/2010