Provider First Line Business Practice Location Address:
518 S HIGHWAY 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANLEY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28164-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-263-0810
Provider Business Practice Location Address Fax Number:
704-263-1222
Provider Enumeration Date:
10/25/2006