Provider First Line Business Practice Location Address:
1054 COLLEGE AVENUE
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:
28080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-853-0173
Provider Business Practice Location Address Fax Number:
704-853-0535
Provider Enumeration Date:
08/10/2007