Provider First Line Business Practice Location Address:
302 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINA GROVE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28023-2471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-857-8769
Provider Business Practice Location Address Fax Number:
704-857-8779
Provider Enumeration Date:
09/07/2005