Provider First Line Business Practice Location Address:
1519 W MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-934-0779
Provider Business Practice Location Address Fax Number:
919-934-4335
Provider Enumeration Date:
07/18/2005