Provider First Line Business Practice Location Address:
9201 UNIVERSITY CITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28223-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-687-4627
Provider Business Practice Location Address Fax Number:
704-687-6715
Provider Enumeration Date:
11/01/2006