Provider First Line Business Practice Location Address:
1011 W FRIENDLY AVENUE
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:
27401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-274-8386
Provider Business Practice Location Address Fax Number:
336-274-8375
Provider Enumeration Date:
08/21/2006