Provider First Line Business Practice Location Address:
C &G GROUP HOME, LLC
Provider Second Line Business Practice Location Address:
508 E. 15TH STREET
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-655-7831
Provider Business Practice Location Address Fax Number:
336-661-3059
Provider Enumeration Date:
05/22/2024