Provider First Line Business Practice Location Address:
1217 DAVIE AVE
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:
28677-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-372-2677
Provider Business Practice Location Address Fax Number:
704-660-4625
Provider Enumeration Date:
01/11/2006