Provider First Line Business Practice Location Address:
1635 NC HWY 66 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-992-1770
Provider Business Practice Location Address Fax Number:
336-992-1776
Provider Enumeration Date:
09/27/2005