Provider First Line Business Practice Location Address: 
35 WOODFIN ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ASHEVILLE
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
28801-3020
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
828-250-5064
    Provider Business Practice Location Address Fax Number: 
828-250-6095
    Provider Enumeration Date: 
11/14/2006