Provider First Line Business Practice Location Address:
15830 BALLANTYNE MEDICAL PL STE 275
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-4791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-542-0744
Provider Business Practice Location Address Fax Number:
704-543-7713
Provider Enumeration Date:
03/12/2013