Provider First Line Business Practice Location Address:
132 ELIZABETH AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-4991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-406-9770
Provider Business Practice Location Address Fax Number:
704-406-9771
Provider Enumeration Date:
09/10/2009