Provider First Line Business Practice Location Address:
126 N RAIFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27576-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-965-2316
Provider Business Practice Location Address Fax Number:
919-965-2400
Provider Enumeration Date:
05/16/2012