Provider First Line Business Practice Location Address:
1236 W INNES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-216-8367
Provider Business Practice Location Address Fax Number:
704-638-3041
Provider Enumeration Date:
01/25/2007