Individual
CARRIE BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CO
Contact information
Practice address
1728 S HAWTHORNE RD, WINSTON SALEM, NC 27103-4016
(336) 768-3666
Mailing address
1728 S HAWTHORNE RD, WINSTON SALEM, NC 27103-4016
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CO 003331
OH
Other
Enumeration date
03/06/2014
Last updated
03/06/2014
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