Provider First Line Business Practice Location Address:
1622 E. NC HYWY 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-967-3032
Provider Business Practice Location Address Fax Number:
919-967-3496
Provider Enumeration Date:
01/22/2007