Provider First Line Business Practice Location Address:
5006 HWY 49 SOUTH
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-454-7948
Provider Business Practice Location Address Fax Number:
704-455-8457
Provider Enumeration Date:
06/03/2006