Provider First Line Business Practice Location Address:
1709 N. LONG STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-4430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-647-9662
Provider Business Practice Location Address Fax Number:
704-647-9663
Provider Enumeration Date:
11/22/2006