Provider First Line Business Practice Location Address:
301 EAST WENDOVER AVE SUITE 111
Provider Second Line Business Practice Location Address:
PIEDMONT ORAL MAXILLOFACIAL FAC CTR
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-273-1000
Provider Business Practice Location Address Fax Number:
336-275-9919
Provider Enumeration Date:
11/16/2006