Provider First Line Business Practice Location Address:
709 N DEKALB ST
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:
28150-3911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-487-2100
Provider Business Practice Location Address Fax Number:
704-482-8779
Provider Enumeration Date:
11/24/2006