Provider First Line Business Practice Location Address:
311 W PHIFER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-624-6643
Provider Business Practice Location Address Fax Number:
704-624-2022
Provider Enumeration Date:
12/19/2005