Provider First Line Business Practice Location Address:
911 WEST HENDERSON STREET, KISER BUILDING
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-347-4144
Provider Business Practice Location Address Fax Number:
704-347-4148
Provider Enumeration Date:
11/17/2010