Provider First Line Business Practice Location Address:
1609 CLEMMONS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27406-2870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-333-2542
Provider Business Practice Location Address Fax Number:
336-333-2858
Provider Enumeration Date:
12/11/2006