Provider First Line Business Practice Location Address:
2627 GRIMSLEY 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:
27403-3135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-279-1227
Provider Business Practice Location Address Fax Number:
336-279-1226
Provider Enumeration Date:
03/13/2009