Provider First Line Business Practice Location Address:
220 E 1ST AVE EXT
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27292-3375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-939-1100
Provider Business Practice Location Address Fax Number:
704-939-1173
Provider Enumeration Date:
05/30/2013