Provider First Line Business Practice Location Address:
807 SCHENCK ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-5122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-482-7311
Provider Business Practice Location Address Fax Number:
704-487-0339
Provider Enumeration Date:
12/14/2009