Provider First Line Business Practice Location Address:
200 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28640-0880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-846-1222
Provider Business Practice Location Address Fax Number:
336-846-1224
Provider Enumeration Date:
11/10/2005