Provider First Line Business Practice Location Address:
2359 HY 105
Provider Second Line Business Practice Location Address:
CDSA OF THE BLUE RIDGE
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-256-5391
Provider Business Practice Location Address Fax Number:
828-265-5394
Provider Enumeration Date:
03/19/2007