Provider First Line Business Practice Location Address:
1410 E FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28112-5160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-289-9869
Provider Business Practice Location Address Fax Number:
704-289-5263
Provider Enumeration Date:
01/29/2008