Provider First Line Business Practice Location Address:
212 W DIXON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28152-6522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-482-9883
Provider Business Practice Location Address Fax Number:
704-482-9842
Provider Enumeration Date:
01/24/2007