Provider First Line Business Practice Location Address:
4100 WELL SPRING DR
Provider Second Line Business Practice Location Address:
LEGACY HEALTHCARE
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
24710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-545-6357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2007