Provider First Line Business Practice Location Address:
844 HWY 39 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-946-6617
Provider Business Practice Location Address Fax Number:
525-946-2313
Provider Enumeration Date:
04/26/2007