Provider First Line Business Practice Location Address:
1201 SCHOOL ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28697-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-838-7609
Provider Business Practice Location Address Fax Number:
336-838-7807
Provider Enumeration Date:
08/01/2006