Provider First Line Business Practice Location Address:
145 SCALEYBARK RD STE B
Provider Second Line Business Practice Location Address:
MELANGE HEALTH SOLUTIONS BUILDING
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209-2682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-297-3826
Provider Business Practice Location Address Fax Number:
704-543-5454
Provider Enumeration Date:
01/28/2007