Graduated: 1988
NPI: 1952452039
Practice Locations (3)
1421 ORCHARD LAKE DR UNIT C
Charlotte, NC 282701475
1421 ORCHARD LAKE DR, UNIT C
CHARLOTTE, NC 282701475
7048440181
1421 ORCHARD LAKE DR C
CHARLOTTE, NC 282701475
Source: CMS National Downloadable File, September 2026.