Provider First Line Business Practice Location Address:
900 SPRING GARDEN ST
Provider Second Line Business Practice Location Address:
136 HHP BUILDING, UNCG ATHLETICS
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27403-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-334-5925
Provider Business Practice Location Address Fax Number:
336-256-0407
Provider Enumeration Date:
07/25/2006