Provider First Line Business Practice Location Address:
2222 LAKE CONCORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANNAPOLIS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-247-9146
Provider Business Practice Location Address Fax Number:
704-786-0086
Provider Enumeration Date:
03/23/2010