Provider First Line Business Practice Location Address:
15830 BALLANTYNE MEDICAL PL STE 275
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:
28277-4791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-302-8659
Provider Business Practice Location Address Fax Number:
980-302-8674
Provider Enumeration Date:
02/02/2017