Provider First Line Business Practice Location Address:
111 W. GROVER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-3824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-482-1006
Provider Business Practice Location Address Fax Number:
704-484-8855
Provider Enumeration Date:
12/15/2010