Provider First Line Business Practice Location Address:
112 S OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLNTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28092-3451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-736-0196
Provider Business Practice Location Address Fax Number:
704-736-9301
Provider Enumeration Date:
03/27/2007