Provider First Line Business Practice Location Address:
1151 S. MAIN ST. APT. 303
Provider Second Line Business Practice Location Address:
LEGACY HEALTHCARE
Provider Business Practice Location Address City Name:
WAKE FOREST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-321-6171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2012