Provider First Line Business Practice Location Address: 
1750 KERNERSVILLE MEDICAL PKWY
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
KERNERSVILLE
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
27284-7146
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
336-564-4000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/02/2022