Provider First Line Business Practice Location Address:
2721 HORSE PEN CREEK RD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27410-8387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-268-2530
Provider Business Practice Location Address Fax Number:
336-268-2531
Provider Enumeration Date:
07/14/2005