Provider First Line Business Practice Location Address:
933 CAROLINA AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-883-8516
Provider Business Practice Location Address Fax Number:
704-883-8560
Provider Enumeration Date:
08/04/2006