Provider First Line Business Practice Location Address:
1519 BOOKER DAIRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-9472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-938-2144
Provider Business Practice Location Address Fax Number:
919-938-2944
Provider Enumeration Date:
09/02/2011