Provider First Line Business Practice Location Address:
145 S POWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28043-3627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-245-9112
Provider Business Practice Location Address Fax Number:
828-245-7542
Provider Enumeration Date:
01/11/2006