Provider First Line Business Practice Location Address:
3541 RANDOLPH RD, SUITE#303
Provider Second Line Business Practice Location Address:
CENTRO MEDICO LATINO
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-333-0465
Provider Business Practice Location Address Fax Number:
704-333-0466
Provider Enumeration Date:
01/20/2007