Provider First Line Business Practice Location Address:
138 PURYEAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROXBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27573-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-615-5210
Provider Business Practice Location Address Fax Number:
252-514-2881
Provider Enumeration Date:
10/10/2006