Provider First Line Business Practice Location Address:
201 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-480-6506
Provider Business Practice Location Address Fax Number:
704-480-8187
Provider Enumeration Date:
07/29/2005