Provider First Line Business Practice Location Address:
1429 E MARION ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-4986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-480-5440
Provider Business Practice Location Address Fax Number:
704-480-5477
Provider Enumeration Date:
03/30/2007