Provider First Line Business Practice Location Address: 
1966 MORGANTON BLVD SW STE B
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LENOIR
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
28645-5311
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
828-426-8457
    Provider Business Practice Location Address Fax Number: 
828-426-8527
    Provider Enumeration Date: 
01/29/2008