Provider First Line Business Practice Location Address:
211 SOUTH CENTER ST.
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677-5873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-838-0016
Provider Business Practice Location Address Fax Number:
704-838-0019
Provider Enumeration Date:
11/21/2006