Provider First Line Business Practice Location Address:
393 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28675-8896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-372-7575
Provider Business Practice Location Address Fax Number:
336-372-7540
Provider Enumeration Date:
08/20/2006