Provider First Line Business Practice Location Address:
1211 VIRGINIA 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:
27401-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-272-0101
Provider Business Practice Location Address Fax Number:
336-272-4063
Provider Enumeration Date:
01/30/2006