Provider First Line Business Practice Location Address:
912 N. ELM 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:
27401-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-274-4669
Provider Business Practice Location Address Fax Number:
336-274-4749
Provider Enumeration Date:
01/10/2006