Provider First Line Business Practice Location Address:
8821 UNIVERSITY EAST DR
Provider Second Line Business Practice Location Address:
SUITE #115
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28213-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-649-6522
Provider Business Practice Location Address Fax Number:
704-503-6250
Provider Enumeration Date:
07/21/2009