Provider First Line Business Practice Location Address:
104-C WEST NORTHWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-1381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-272-6235
Provider Business Practice Location Address Fax Number:
336-574-1486
Provider Enumeration Date:
11/28/2006