Provider First Line Business Practice Location Address:
1620 S MARTIN LUTHER KING JR AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-5594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-642-1250
Provider Business Practice Location Address Fax Number:
704-642-1250
Provider Enumeration Date:
03/20/2007