Provider First Line Business Practice Location Address:
35 FACILITY DRIVE
Provider Second Line Business Practice Location Address:
MEDWEST
Provider Business Practice Location Address City Name:
CLYDE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-452-5042
Provider Business Practice Location Address Fax Number:
828-452-9225
Provider Enumeration Date:
05/24/2005