Provider First Line Business Practice Location Address:
250 SMITH CHURCH RD
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:
27870-4914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-672-7732
Provider Business Practice Location Address Fax Number:
252-635-6951
Provider Enumeration Date:
08/24/2007