Provider First Line Business Practice Location Address:
131 W PARRIS AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27262-7852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-889-9977
Provider Business Practice Location Address Fax Number:
336-889-9977
Provider Enumeration Date:
09/28/2007