Provider First Line Business Practice Location Address:
40 S. GRAYSON ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-372-8299
Provider Business Practice Location Address Fax Number:
336-372-2291
Provider Enumeration Date:
08/26/2008