Provider First Line Business Practice Location Address:
200 BAKER DRIVE
Provider Second Line Business Practice Location Address:
BAKER SPORTS COMPLEX
Provider Business Practice Location Address City Name:
DAVIDSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28035-7158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-894-2774
Provider Business Practice Location Address Fax Number:
704-894-2802
Provider Enumeration Date:
02/18/2009