Provider First Line Business Practice Location Address:
118 N ELLIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-637-5401
Provider Business Practice Location Address Fax Number:
704-637-5095
Provider Enumeration Date:
11/08/2005