Provider First Line Business Practice Location Address:
338 N ELM ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-2177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-272-5252
Provider Business Practice Location Address Fax Number:
336-272-0939
Provider Enumeration Date:
08/29/2007