Provider First Line Business Practice Location Address:
149 W PARKER RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-4673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-322-2183
Provider Business Practice Location Address Fax Number:
828-322-2389
Provider Enumeration Date:
12/05/2012