Provider First Line Business Practice Location Address:
1388 LEWIS FORK BAPTIST CHURCH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERGUSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28624-9080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-262-5450
Provider Business Practice Location Address Fax Number:
828-262-5730
Provider Enumeration Date:
02/22/2007