Provider First Line Business Practice Location Address:
2214 ATLANTA 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:
27406-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-272-9503
Provider Business Practice Location Address Fax Number:
336-378-9478
Provider Enumeration Date:
02/26/2007