Provider First Line Business Practice Location Address:
144 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE FALLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28630-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-754-3888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2012