Provider First Line Business Practice Location Address:
809 N LAFAYETTE ST STE A
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:
28150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-284-0554
Provider Business Practice Location Address Fax Number:
704-448-2003
Provider Enumeration Date:
12/09/2014