Provider First Line Business Practice Location Address:
90 S MAIN ST
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:
28675-9643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-372-8747
Provider Business Practice Location Address Fax Number:
336-372-9166
Provider Enumeration Date:
10/12/2012