Provider First Line Business Practice Location Address:
12925 HWY 601 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-888-2114
Provider Business Practice Location Address Fax Number:
704-888-2125
Provider Enumeration Date:
06/22/2006