Provider First Line Business Practice Location Address:
126 N SALEM ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27502-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-342-5778
Provider Business Practice Location Address Fax Number:
919-342-4613
Provider Enumeration Date:
08/09/2006