Provider First Line Business Practice Location Address:
13523 PLAZA ROAD EXTENSION
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:
28215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-316-4990
Provider Business Practice Location Address Fax Number:
704-316-4998
Provider Enumeration Date:
08/15/2007