Provider First Line Business Practice Location Address:
920 CHURCH ST N
Provider Second Line Business Practice Location Address:
NORTHEAST PHYSICIAN NETWORK
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-403-1780
Provider Business Practice Location Address Fax Number:
704-795-2181
Provider Enumeration Date:
03/29/2006