Provider First Line Business Practice Location Address:
2400 S MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27263-1945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-889-3831
Provider Business Practice Location Address Fax Number:
336-889-7269
Provider Enumeration Date:
11/07/2006