Provider First Line Business Practice Location Address:
1704 NC HIGHWAY 39 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27549-8329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-496-7222
Provider Business Practice Location Address Fax Number:
919-497-5450
Provider Enumeration Date:
10/01/2007