Provider First Line Business Practice Location Address:
1126 N CHURCH ST STE 101
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:
27401-1035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-763-1007
Provider Business Practice Location Address Fax Number:
336-763-3144
Provider Enumeration Date:
12/19/2005