Provider First Line Business Practice Location Address:
414 E FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677-5909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-873-2831
Provider Business Practice Location Address Fax Number:
704-878-0360
Provider Enumeration Date:
10/24/2006