Provider First Line Business Practice Location Address:
228 FAIRPLAINS SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28659-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-667-5926
Provider Business Practice Location Address Fax Number:
336-667-8295
Provider Enumeration Date:
10/15/2013