Provider First Line Business Practice Location Address:
211 W LEXINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27262-2578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-884-1475
Provider Business Practice Location Address Fax Number:
336-884-1472
Provider Enumeration Date:
09/13/2010