Provider First Line Business Practice Location Address:
417 S SHARON AMITY RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-2875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-517-9116
Provider Business Practice Location Address Fax Number:
704-372-9881
Provider Enumeration Date:
07/06/2006