Provider First Line Business Practice Location Address:
1427 E MARION ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-4980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-406-9770
Provider Business Practice Location Address Fax Number:
704-939-1173
Provider Enumeration Date:
10/03/2006