Provider First Line Business Practice Location Address:
1929 ROANOKE AVE
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:
27870-4333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-537-4888
Provider Business Practice Location Address Fax Number:
252-537-4811
Provider Enumeration Date:
11/13/2006