Provider First Line Business Practice Location Address:
1320 US HIGHWAY 221 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28640-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-246-6991
Provider Business Practice Location Address Fax Number:
336-246-6927
Provider Enumeration Date:
10/26/2005