Provider First Line Business Practice Location Address:
461 MOODY FARM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAGGIE VALLEY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28751-9684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-631-1852
Provider Business Practice Location Address Fax Number:
828-631-2534
Provider Enumeration Date:
11/19/2009