Provider First Line Business Practice Location Address:
210 A SMITH CHURCH ROAD
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:
27870-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-535-8463
Provider Business Practice Location Address Fax Number:
252-535-8137
Provider Enumeration Date:
04/07/2007