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1003044066
TIMOTHY CARL BLAKE
WINSTON SALEM, NC
NPI
1003044066
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
Enumeration Date
2009-06-29
Last Update Date
2009-06-29
Business Address
-- TIMOTHY CARL BLAKE
725 HIGHLAND AVE
WINSTON SALEM, NC 27101-4206
Phone number: 336-607-8523
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Mailing Address
-- TIMOTHY CARL BLAKE
284 EXECUTIVE PARK DR SUITE 100
CONCORD, NC 28025-1831
Phone number:
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