Provider First Line Business Practice Location Address:
137 JENNINGS RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28625-9598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-876-4277
Provider Business Practice Location Address Fax Number:
704-876-8725
Provider Enumeration Date:
11/29/2006