Provider First Line Business Practice Location Address:
11600 N COMMUNITY HOUSE RD
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-927-5885
Provider Business Practice Location Address Fax Number:
866-372-5885
Provider Enumeration Date:
07/02/2006