Provider First Line Business Practice Location Address:
2620 EAST SEVENTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-4381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-332-7141
Provider Business Practice Location Address Fax Number:
704-342-3324
Provider Enumeration Date:
04/06/2006