Provider First Line Business Practice Location Address:
4221 GARRETT RD STE 2
Provider Second Line Business Practice Location Address:
ACTIVEDGE FITNESS & SPORTS PERFORMANCE
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-3467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-493-1204
Provider Business Practice Location Address Fax Number:
919-493-1204
Provider Enumeration Date:
10/11/2006