Provider First Line Business Practice Location Address:
140 BAKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCHDALE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-875-5917
Provider Business Practice Location Address Fax Number:
336-875-5919
Provider Enumeration Date:
01/12/2018