Provider First Line Business Practice Location Address:
143 MARGINAL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOLEEMEE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27014-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-633-7220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2011