Provider First Line Business Practice Location Address:
338 S SHARON AMITY RD
Provider Second Line Business Practice Location Address:
#159
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-649-2385
Provider Business Practice Location Address Fax Number:
704-536-9541
Provider Enumeration Date:
06/30/2008