Provider First Line Business Practice Location Address:
412 NORTHRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27403-1460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-855-8508
Provider Business Practice Location Address Fax Number:
363-676-8819
Provider Enumeration Date:
02/08/2007