Provider First Line Business Practice Location Address:
287 PREMIER BLVD
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
ROANOKE RAPIDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27870-5076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-537-4456
Provider Business Practice Location Address Fax Number:
252-537-6168
Provider Enumeration Date:
12/28/2006