Provider First Line Business Practice Location Address:
1005 CARTHAGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27331-0066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-774-9522
Provider Business Practice Location Address Fax Number:
919-774-8560
Provider Enumeration Date:
11/01/2006