Provider First Line Business Practice Location Address:
608 JACKSON ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
ROANOKE RAPIDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27870-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-416-4700
Provider Business Practice Location Address Fax Number:
919-416-0821
Provider Enumeration Date:
04/08/2014