Provider First Line Business Practice Location Address:
1203 NORTHUP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REIDSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27320-5511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-342-3159
Provider Business Practice Location Address Fax Number:
336-349-2277
Provider Enumeration Date:
05/18/2006