Provider First Line Business Practice Location Address:
5408 HIGHWAY 49 S
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:
28075-8469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-455-9011
Provider Business Practice Location Address Fax Number:
704-455-1747
Provider Enumeration Date:
07/19/2006