Provider First Line Business Practice Location Address:
1403 N LAFAYETTE ST
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:
28150-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-482-1447
Provider Business Practice Location Address Fax Number:
704-481-9744
Provider Enumeration Date:
04/03/2006