Provider First Line Business Practice Location Address:
247 OAK ST EXTENSION
Provider Second Line Business Practice Location Address:
SUITE 145
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28043-3585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-245-5003
Provider Business Practice Location Address Fax Number:
828-245-5798
Provider Enumeration Date:
06/09/2006