Provider First Line Business Practice Location Address:
912 NORTH ELM STREET
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:
336-558-4720
Provider Business Practice Location Address Fax Number:
336-274-4647
Provider Enumeration Date:
07/01/2009