Provider First Line Business Practice Location Address:
102 HEALTH SERVICE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-372-4095
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2011