Provider First Line Business Practice Location Address:
4852 US HIGHWAY 158
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:
27870-8948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-535-1192
Provider Business Practice Location Address Fax Number:
252-535-1147
Provider Enumeration Date:
12/14/2007