Provider First Line Business Practice Location Address:
127 SCALEYBARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-333-1435
Provider Business Practice Location Address Fax Number:
704-602-2440
Provider Enumeration Date:
01/18/2007