Provider First Line Business Practice Location Address:
502 NORTH ELAM AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-292-0863
Provider Business Practice Location Address Fax Number:
336-292-2583
Provider Enumeration Date:
01/25/2007