Provider First Line Business Practice Location Address:
13289 SPIVEYS CORNER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28382-7405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-627-2410
Provider Business Practice Location Address Fax Number:
910-564-2980
Provider Enumeration Date:
08/23/2023