Provider First Line Business Practice Location Address:
1101 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-337-0144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006