Provider First Line Business Practice Location Address:
913 N CAROLINA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-871-1045
Provider Business Practice Location Address Fax Number:
704-883-8638
Provider Enumeration Date:
01/22/2007