Provider First Line Business Practice Location Address:
112 N SWAIM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28642-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-526-7282
Provider Business Practice Location Address Fax Number:
336-526-7283
Provider Enumeration Date:
07/07/2005