Provider First Line Business Practice Location Address:
301 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANDIS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-857-2238
Provider Business Practice Location Address Fax Number:
704-857-2239
Provider Enumeration Date:
07/08/2005