Provider First Line Business Practice Location Address:
715 HARTFORD AVENUE
Provider Second Line Business Practice Location Address:
SEDGEFIELD ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-343-5826
Provider Business Practice Location Address Fax Number:
980-343-5856
Provider Enumeration Date:
03/25/2010