Provider First Line Business Practice Location Address:
417 W WARREN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-5329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-487-9399
Provider Business Practice Location Address Fax Number:
704-487-9388
Provider Enumeration Date:
04/13/2007