Provider First Line Business Practice Location Address:
3776 STATE HWY 49
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-426-3566
Provider Business Practice Location Address Fax Number:
704-426-2566
Provider Enumeration Date:
09/13/2006