Provider First Line Business Practice Location Address:
1617 NC HWY 66 SOUTH
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284-3829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-993-2224
Provider Business Practice Location Address Fax Number:
336-993-0382
Provider Enumeration Date:
05/27/2005