Provider First Line Business Practice Location Address:
620 NC HIGHWAY 42 W
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:
27520-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-400-7909
Provider Business Practice Location Address Fax Number:
919-243-0530
Provider Enumeration Date:
09/20/2005