Provider First Line Business Practice Location Address:
425 SOUTH SHARON AMITY ROAD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-364-3422
Provider Business Practice Location Address Fax Number:
704-364-3511
Provider Enumeration Date:
09/25/2006