Provider First Line Business Practice Location Address:
1002 N CHURCH ST
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-1448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-274-7581
Provider Business Practice Location Address Fax Number:
336-274-7584
Provider Enumeration Date:
06/27/2005