Provider First Line Business Practice Location Address:
16623 BIRKDALE PWKY
Provider Second Line Business Practice Location Address:
SUITE 110, NE PEDIATRIC NEURO, HUNTERSVILLE
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-987-4277
Provider Business Practice Location Address Fax Number:
704-987-5096
Provider Enumeration Date:
01/18/2007