Provider First Line Business Practice Location Address:
806B PLAZA 66 HWY 66 S
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-992-1111
Provider Business Practice Location Address Fax Number:
336-992-1111
Provider Enumeration Date:
09/22/2006