Provider First Line Business Practice Location Address: 
201 E PARKER RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
MORGANTON
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
28655-5107
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
828-433-1235
    Provider Business Practice Location Address Fax Number: 
828-433-1992
    Provider Enumeration Date: 
10/26/2006