Provider First Line Business Practice Location Address:
106 NORTH FIRST AVENUE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KNIGHTDALE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-332-1819
Provider Business Practice Location Address Fax Number:
919-341-8495
Provider Enumeration Date:
04/15/2009