Provider First Line Business Practice Location Address:
1198 WYKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-4259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-487-5337
Provider Business Practice Location Address Fax Number:
704-487-7584
Provider Enumeration Date:
11/13/2006