Provider First Line Business Practice Location Address:
3126 DALLAS HIGH SHOALS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28034-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-922-8911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2012