Provider First Line Business Practice Location Address:
420 E CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT HOLLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28120-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-277-2770
Provider Business Practice Location Address Fax Number:
980-209-6560
Provider Enumeration Date:
11/30/2005