Provider First Line Business Practice Location Address:
1427 E WASHINGTON 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:
27401-3451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-272-9963
Provider Business Practice Location Address Fax Number:
336-272-9963
Provider Enumeration Date:
01/25/2008