Provider First Line Business Practice Location Address:
9560 COUNTY LINE RD
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:
27284-8730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
743-762-2655
Provider Business Practice Location Address Fax Number:
743-762-2651
Provider Enumeration Date:
08/18/2026