Provider First Line Business Practice Location Address:
201 W MARION ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-5091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-487-6226
Provider Business Practice Location Address Fax Number:
704-487-6286
Provider Enumeration Date:
02/06/2007