Provider First Line Business Practice Location Address:
238 W KINGS HWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27288-5095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-623-3030
Provider Business Practice Location Address Fax Number:
336-623-3031
Provider Enumeration Date:
09/22/2009