Provider First Line Business Practice Location Address:
2147 DAVIE AVE
Provider Second Line Business Practice Location Address:
GARDENS OF STATESVILLE
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28625-9200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-878-8689
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2006