Provider First Line Business Practice Location Address:
1623 YORK AVE STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-2355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-884-8658
Provider Business Practice Location Address Fax Number:
336-884-0920
Provider Enumeration Date:
01/10/2007