Provider First Line Business Practice Location Address:
1157 E MARION ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-4890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-487-6866
Provider Business Practice Location Address Fax Number:
704-481-9633
Provider Enumeration Date:
01/27/2010