Provider First Line Business Practice Location Address:
1700 ABBEY PL
Provider Second Line Business Practice Location Address:
STE 200 PARK ROAD MEDICAL CLINIC
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209-3742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-523-2565
Provider Business Practice Location Address Fax Number:
704-344-1241
Provider Enumeration Date:
05/25/2006