Provider First Line Business Practice Location Address:
1699 OLD US 70 HWY W
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:
27520-6566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-359-1699
Provider Business Practice Location Address Fax Number:
919-359-1697
Provider Enumeration Date:
12/29/2010