Provider First Line Business Practice Location Address:
1628 DUNBAR 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:
27401-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-772-2491
Provider Business Practice Location Address Fax Number:
336-373-3962
Provider Enumeration Date:
06/11/2014