Provider First Line Business Practice Location Address:
640 STATESVILLE BLVD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-2282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-637-3636
Provider Business Practice Location Address Fax Number:
704-637-3184
Provider Enumeration Date:
05/31/2007