Provider First Line Business Practice Location Address:
1420 E SEVENTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-375-0100
Provider Business Practice Location Address Fax Number:
704-375-8623
Provider Enumeration Date:
11/07/2005