Provider First Line Business Practice Location Address:
132 ELIZABETH AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-4992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-914-8197
Provider Business Practice Location Address Fax Number:
980-368-5845
Provider Enumeration Date:
02/09/2026