Provider First Line Business Practice Location Address:
12190 UNIVERSITY CITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28075-7406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-844-4147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2015