Provider First Line Business Practice Location Address:
6845 HIGHWAY 135
Provider Second Line Business Practice Location Address:
MCMICHAEL HIGH SCHOOL
Provider Business Practice Location Address City Name:
MAYODAN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-427-4335
Provider Business Practice Location Address Fax Number:
336-427-4335
Provider Enumeration Date:
11/13/2006