Provider First Line Business Practice Location Address:
8161 ARDREY KELL RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-845-1425
Provider Business Practice Location Address Fax Number:
704-845-1580
Provider Enumeration Date:
05/31/2007