Provider First Line Business Practice Location Address:
4412 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-637-3040
Provider Business Practice Location Address Fax Number:
704-637-1583
Provider Enumeration Date:
05/20/2006