Provider First Line Business Practice Location Address:
1675 E CENTER STREET EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27292-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-248-8914
Provider Business Practice Location Address Fax Number:
336-248-2138
Provider Enumeration Date:
01/25/2007