Provider First Line Business Practice Location Address:
12 W MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28681-2753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-635-7377
Provider Business Practice Location Address Fax Number:
828-635-7569
Provider Enumeration Date:
06/20/2005