Provider First Line Business Practice Location Address:
620 S LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-481-0076
Provider Business Practice Location Address Fax Number:
704-481-0080
Provider Enumeration Date:
02/21/2007