Provider First Line Business Practice Location Address:
205 E. MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YADKINVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-679-3385
Provider Business Practice Location Address Fax Number:
336-679-8636
Provider Enumeration Date:
03/28/2007