Provider First Line Business Practice Location Address:
5155 WESTERN AVE
Provider Second Line Business Practice Location Address:
PO DRAWER 1439
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-9696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-438-6037
Provider Business Practice Location Address Fax Number:
828-439-2312
Provider Enumeration Date:
06/04/2008