Provider First Line Business Practice Location Address:
444 JACKSON ST
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:
27870-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-537-3401
Provider Business Practice Location Address Fax Number:
252-537-8872
Provider Enumeration Date:
12/08/2005