Provider First Line Business Practice Location Address:
100 BEATTIES FORD ROAD
Provider Second Line Business Practice Location Address:
JOHNSON C SMITH UNIVERSITY, DEPT OF SOCIAL WORK
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28216-5398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-378-1094
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2007