Provider First Line Business Practice Location Address:
559 JACKSON PARK RD
Provider Second Line Business Practice Location Address:
KANNAPOLIS INT MED
Provider Business Practice Location Address City Name:
KANNAPOLIS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28083-3657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-932-1155
Provider Business Practice Location Address Fax Number:
704-932-3500
Provider Enumeration Date:
02/03/2006