Provider First Line Business Practice Location Address:
128 MEDICAL PARK RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28117-8578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-658-1001
Provider Business Practice Location Address Fax Number:
704-658-1002
Provider Enumeration Date:
11/07/2005