Provider First Line Business Practice Location Address:
103 WEST CHEEK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-372-7644
Provider Business Practice Location Address Fax Number:
336-372-7655
Provider Enumeration Date:
11/02/2010