Provider First Line Business Practice Location Address:
2440 STATESVILLE BLVD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28147-7128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-216-9153
Provider Business Practice Location Address Fax Number:
704-216-9155
Provider Enumeration Date:
01/17/2007