Provider First Line Business Practice Location Address:
223 WEST 12TH
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:
28144-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-637-7562
Provider Business Practice Location Address Fax Number:
704-636-0075
Provider Enumeration Date:
12/11/2006