Provider First Line Business Practice Location Address:
4702 NC HIGHWAY 48
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:
27870-8505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-532-7736
Provider Business Practice Location Address Fax Number:
434-634-4834
Provider Enumeration Date:
02/01/2007