Provider First Line Business Practice Location Address:
550 BROOKDALE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-873-0545
Provider Business Practice Location Address Fax Number:
704-873-0546
Provider Enumeration Date:
12/29/2005