Provider First Line Business Practice Location Address:
14233 NC HIGHWAY 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALIFAX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27839-8773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-378-8561
Provider Business Practice Location Address Fax Number:
804-988-5254
Provider Enumeration Date:
08/26/2026