Provider First Line Business Practice Location Address:
13700 PROVIDENCE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEDDINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28104-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-246-7551
Provider Business Practice Location Address Fax Number:
888-978-1972
Provider Enumeration Date:
10/29/2026