Provider First Line Business Practice Location Address:
240 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:
27870-4903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-535-1082
Provider Business Practice Location Address Fax Number:
252-537-8440
Provider Enumeration Date:
05/27/2006