Individual
MR. STATE WITHERSPOON ALEXANDER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8933 RAVEN PARK DR, CHARLOTTE, NC 28216-1685
(704) 307-3009
Mailing address
8933 RAVEN PARK DR, CHARLOTTE, NC 28216-1685
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
27783321
NC
Other
Enumeration date
07/16/2015
Last updated
07/16/2015
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