Provider First Line Business Practice Location Address:
415 N EDGEWORTH ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-2182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-574-2404
Provider Business Practice Location Address Fax Number:
336-574-2405
Provider Enumeration Date:
03/30/2007