Provider First Line Business Practice Location Address:
8401 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-8797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-887-4531
Provider Business Practice Location Address Fax Number:
704-316-3821
Provider Enumeration Date:
01/14/2010