Provider First Line Business Practice Location Address:
422 HIGHWAY 29 N
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:
28023-0017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-856-2579
Provider Business Practice Location Address Fax Number:
704-855-5556
Provider Enumeration Date:
02/11/2009