Provider First Line Business Practice Location Address:
201 PATTERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINA GROVE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28023-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-857-7497
Provider Business Practice Location Address Fax Number:
704-857-8497
Provider Enumeration Date:
07/17/2006