Provider First Line Business Practice Location Address:
108 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROBERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-795-3130
Provider Business Practice Location Address Fax Number:
252-795-5511
Provider Enumeration Date:
10/12/2005