Provider First Line Business Practice Location Address: 
601 N ELM ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HIGH POINT
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
27262-4331
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
336-878-6000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/03/2019