Provider First Line Business Practice Location Address:
111 GATEWAY CENTER DR
Provider Second Line Business Practice Location Address:
DBA PRIMECARE KERNERSVILLE
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284-2999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-996-2173
Provider Business Practice Location Address Fax Number:
336-996-3254
Provider Enumeration Date:
05/02/2006