Provider First Line Business Practice Location Address:
913 CAROLINA AVE. N.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-871-0937
Provider Business Practice Location Address Fax Number:
704-871-9419
Provider Enumeration Date:
03/28/2007