Provider First Line Business Practice Location Address:
2116 STATESVILLE BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28147-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-639-1060
Provider Business Practice Location Address Fax Number:
800-311-7783
Provider Enumeration Date:
09/25/2006