Provider First Line Business Practice Location Address:
549 HIGHLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT HOLLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28120-2188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-822-0007
Provider Business Practice Location Address Fax Number:
704-822-2008
Provider Enumeration Date:
12/20/2006