Provider First Line Business Practice Location Address:
707 S LAFAYETTE ST
Provider Second Line Business Practice Location Address:
SUITE 1 & 2
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-5819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-487-1433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2012