Provider First Line Business Practice Location Address:
15830 BALLANTYNE MEDICAL PL STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-0762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-341-0090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2006