Provider First Line Business Practice Location Address:
1401 S SCALES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REIDSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27320-5634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-634-1555
Provider Business Practice Location Address Fax Number:
336-634-1005
Provider Enumeration Date:
07/26/2009