Provider First Line Business Practice Location Address:
1400 5TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-502-8164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2009