Provider First Line Business Practice Location Address:
124 S POWELL ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28043-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-382-0171
Provider Business Practice Location Address Fax Number:
828-382-0171
Provider Enumeration Date:
03/17/2010