Provider First Line Business Practice Location Address: 
31 COLLEGE PL
    Provider Second Line Business Practice Location Address: 
B100
    Provider Business Practice Location Address City Name: 
ASHEVILLE
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
28801-2483
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
828-254-5008
    Provider Business Practice Location Address Fax Number: 
828-254-5808
    Provider Enumeration Date: 
08/12/2009