Provider First Line Business Practice Location Address:
513 S DEKALB 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:
28150-5926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-406-9939
Provider Business Practice Location Address Fax Number:
704-406-9940
Provider Enumeration Date:
09/09/2011