Provider First Line Business Practice Location Address:
1476 S MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. PLEASANT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28124-0847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-436-9397
Provider Business Practice Location Address Fax Number:
704-436-2203
Provider Enumeration Date:
12/11/2006