Provider First Line Business Practice Location Address:
321 HWY. 125
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:
27870-6445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-535-1070
Provider Business Practice Location Address Fax Number:
252-535-1090
Provider Enumeration Date:
03/20/2007