Provider First Line Business Practice Location Address:
2650 S LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28152-7583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-481-8054
Provider Business Practice Location Address Fax Number:
704-480-7628
Provider Enumeration Date:
12/29/2006