Provider First Line Business Practice Location Address:
1009 W MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-708-0642
Provider Business Practice Location Address Fax Number:
336-292-3655
Provider Enumeration Date:
11/02/2007