Provider First Line Business Practice Location Address:
633 OLD LANDFILL ROAD
Provider Second Line Business Practice Location Address:
NC DEPARTMENT OF CORRECTIONS AXCI 4870
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28681-0909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-632-1331
Provider Business Practice Location Address Fax Number:
828-632-1346
Provider Enumeration Date:
06/06/2008