Provider First Line Business Practice Location Address:
215 SMITH CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE RAPIDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27870-4913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-535-2311
Provider Business Practice Location Address Fax Number:
252-937-4103
Provider Enumeration Date:
06/24/2005