Provider First Line Business Practice Location Address:
712 N ELM ST
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:
27262-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-889-5422
Provider Business Practice Location Address Fax Number:
336-889-3202
Provider Enumeration Date:
01/25/2007