Provider First Line Business Practice Location Address:
1505 W FRIENDLY AVE
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:
27403-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-273-1782
Provider Business Practice Location Address Fax Number:
336-273-3684
Provider Enumeration Date:
10/03/2006