Provider First Line Business Practice Location Address:
1307 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YADKINVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27055-7811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-677-3869
Provider Business Practice Location Address Fax Number:
336-677-1351
Provider Enumeration Date:
06/30/2008