Provider First Line Business Practice Location Address:
2640 S MAIN 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:
27263-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-889-0170
Provider Business Practice Location Address Fax Number:
336-889-0172
Provider Enumeration Date:
07/12/2008