Provider First Line Business Practice Location Address:
112 WOODLAWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT HOLLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28120-1775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-827-3575
Provider Business Practice Location Address Fax Number:
704-827-0840
Provider Enumeration Date:
12/28/2006