Provider First Line Business Practice Location Address:
292 SOUTH MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-859-2121
Provider Business Practice Location Address Fax Number:
336-859-2122
Provider Enumeration Date:
11/13/2006