Provider First Line Business Practice Location Address:
807 SCHENCK STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-5123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-487-2340
Provider Business Practice Location Address Fax Number:
980-487-2341
Provider Enumeration Date:
01/12/2010