Provider First Line Business Practice Location Address:
146 MEDICAL PARK ROAD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28117-8529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-662-0877
Provider Business Practice Location Address Fax Number:
704-662-0875
Provider Enumeration Date:
12/29/2007