Provider First Line Business Practice Location Address:
1710 KERNERSVILLE MEDICAL PKWY STE 116
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284-7156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-564-4170
Provider Business Practice Location Address Fax Number:
336-564-4936
Provider Enumeration Date:
10/07/2010