Provider First Line Business Practice Location Address: 
144 RESERVATION DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SPINDALE
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
28160-1566
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
828-287-0200
    Provider Business Practice Location Address Fax Number: 
828-287-8755
    Provider Enumeration Date: 
10/27/2006