Provider First Line Business Practice Location Address:
425 SPRING GARDEN 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:
27401-2733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-379-0199
Provider Business Practice Location Address Fax Number:
336-574-1139
Provider Enumeration Date:
03/31/2007