Provider First Line Business Practice Location Address:
2219 E 7TH ST
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:
28204-3339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-377-7099
Provider Business Practice Location Address Fax Number:
704-377-7983
Provider Enumeration Date:
11/20/2006