Provider First Line Business Practice Location Address:
248 DOCTORS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28675-9421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-372-2481
Provider Business Practice Location Address Fax Number:
336-372-4153
Provider Enumeration Date:
07/28/2005