Provider First Line Business Practice Location Address:
12 FALLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE FALLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28630-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-212-0301
Provider Business Practice Location Address Fax Number:
818-212-0802
Provider Enumeration Date:
03/23/2026