Provider First Line Business Practice Location Address:
1240 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28697-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-838-8842
Provider Business Practice Location Address Fax Number:
336-838-5387
Provider Enumeration Date:
09/27/2006