Provider First Line Business Practice Location Address:
123 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANNAPOLIS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-933-2225
Provider Business Practice Location Address Fax Number:
704-933-8855
Provider Enumeration Date:
08/10/2006