Provider First Line Business Practice Location Address:
114.5 W. INNES STREET
Provider Second Line Business Practice Location Address:
SUITE-1
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-9711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-598-1882
Provider Business Practice Location Address Fax Number:
704-596-7366
Provider Enumeration Date:
01/17/2007