Provider First Line Business Practice Location Address:
2500 N CHURCH 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:
27405-4314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-375-2240
Provider Business Practice Location Address Fax Number:
336-375-2214
Provider Enumeration Date:
10/31/2011