Provider First Line Business Practice Location Address:
1825 OAKDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28216-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-343-6076
Provider Business Practice Location Address Fax Number:
980-343-6134
Provider Enumeration Date:
05/11/2026