Provider First Line Business Practice Location Address:
204 E INNES ST
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-5010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-630-4673
Provider Business Practice Location Address Fax Number:
704-630-4663
Provider Enumeration Date:
01/19/2007