Provider First Line Business Practice Location Address:
109 MUIRS CHAPEL RD
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27410-6161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-542-2903
Provider Business Practice Location Address Fax Number:
336-542-2929
Provider Enumeration Date:
08/27/2007