Provider First Line Business Practice Location Address:
197 OLD FARM 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:
27870-3343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-443-9955
Provider Business Practice Location Address Fax Number:
252-210-3466
Provider Enumeration Date:
12/02/2015