Provider First Line Business Practice Location Address:
315 E WASHINGTON ST
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:
27401-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-387-6161
Provider Business Practice Location Address Fax Number:
336-387-9167
Provider Enumeration Date:
09/26/2006