Provider First Line Business Practice Location Address:
143 JOE KNOX AVE
Provider Second Line Business Practice Location Address:
MOORESVILLE
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28117-9243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-662-3660
Provider Business Practice Location Address Fax Number:
704-662-3595
Provider Enumeration Date:
03/22/2011