Provider First Line Business Practice Location Address:
400 ROYSTER AVE
Provider Second Line Business Practice Location Address:
SUITE 1, 2A ,2B,3,4
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-6503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-471-2128
Provider Business Practice Location Address Fax Number:
704-471-0989
Provider Enumeration Date:
09/10/2007