Provider First Line Business Practice Location Address:
923 N 2ND ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
ALBEMARLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28001-3369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-982-0122
Provider Business Practice Location Address Fax Number:
704-982-0125
Provider Enumeration Date:
06/24/2006