Provider First Line Business Practice Location Address:
1000 BLYTHE BLVD
Provider Second Line Business Practice Location Address:
CMC DEPT OF ORAL MEDICINE
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28203-5812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-355-4197
Provider Business Practice Location Address Fax Number:
704-355-5301
Provider Enumeration Date:
07/01/2011