Provider First Line Business Practice Location Address:
2607 TABERNACLE CHURCH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT GARDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-674-2328
Provider Business Practice Location Address Fax Number:
336-674-7158
Provider Enumeration Date:
04/16/2007