Provider First Line Business Practice Location Address:
170 MEDICAL PARK RD
Provider Second Line Business Practice Location Address:
SUITE 102A
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-663-5240
Provider Business Practice Location Address Fax Number:
704-663-5399
Provider Enumeration Date:
10/04/2006