Provider First Line Business Practice Location Address:
1146 COUNTY HOME RD
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:
28152-6952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-261-3092
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2019