Provider First Line Business Practice Location Address:
1508 W INNES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-630-9656
Provider Business Practice Location Address Fax Number:
704-630-9658
Provider Enumeration Date:
11/23/2005