Provider First Line Business Practice Location Address:
806 N LAFAYETTE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-482-1334
Provider Business Practice Location Address Fax Number:
704-482-2664
Provider Enumeration Date:
05/30/2008