Provider First Line Business Practice Location Address:
21 FALLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE FALLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-396-2144
Provider Business Practice Location Address Fax Number:
828-396-9561
Provider Enumeration Date:
02/08/2007