Provider First Line Business Practice Location Address:
1955 S US 29 HWY
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:
28023-5684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-210-7790
Provider Business Practice Location Address Fax Number:
704-210-7791
Provider Enumeration Date:
06/24/2014