Provider First Line Business Practice Location Address:
1121 S MAIN ST
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:
27292-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-633-7576
Provider Business Practice Location Address Fax Number:
704-633-7521
Provider Enumeration Date:
11/15/2005