Provider First Line Business Practice Location Address:
4884 NC HIGHWAY 42 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27527-8870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-887-9781
Provider Business Practice Location Address Fax Number:
919-869-1780
Provider Enumeration Date:
07/27/2015