Provider First Line Business Practice Location Address:
590 MEDICAL PARK DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-649-9566
Provider Business Practice Location Address Fax Number:
828-649-0687
Provider Enumeration Date:
05/31/2005