Provider First Line Business Practice Location Address:
921 N LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-3832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-482-0901
Provider Business Practice Location Address Fax Number:
704-482-2081
Provider Enumeration Date:
07/24/2008