Provider First Line Business Practice Location Address: 
5170 NC HIGHWAY 105 S STE 1
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BANNER ELK
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
28604-8734
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
828-898-4145
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/21/2023