Provider First Line Business Practice Location Address:
2310 N CENTENNIAL ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-884-4118
Provider Business Practice Location Address Fax Number:
336-884-1519
Provider Enumeration Date:
12/27/2006