Provider First Line Business Practice Location Address:
113 W 10TH STREET
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:
27870-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-533-0045
Provider Business Practice Location Address Fax Number:
252-533-0046
Provider Enumeration Date:
03/20/2007