Provider First Line Business Practice Location Address:
145 W DIXON BLVD
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:
28152-6546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-482-0135
Provider Business Practice Location Address Fax Number:
704-482-0155
Provider Enumeration Date:
08/06/2013