Provider First Line Business Practice Location Address:
130 S MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-442-5126
Provider Business Practice Location Address Fax Number:
252-442-8036
Provider Enumeration Date:
10/04/2006