Provider First Line Business Practice Location Address:
1607 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANNAPOLIS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28081-2317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-933-0809
Provider Business Practice Location Address Fax Number:
704-932-6964
Provider Enumeration Date:
03/22/2006