Provider First Line Business Practice Location Address:
1509 E INNES ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28146-6018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-738-2245
Provider Business Practice Location Address Fax Number:
704-738-2246
Provider Enumeration Date:
05/25/2006