Provider First Line Business Practice Location Address:
153 BARIUM SPRINGS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-873-1011
Provider Business Practice Location Address Fax Number:
704-832-2253
Provider Enumeration Date:
09/20/2011