Provider First Line Business Practice Location Address: 
301 E MEETING ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
MORGANTON
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
28655-3593
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
828-659-3418
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/08/2012