Provider First Line Business Practice Location Address:
121 ELLERBE GROVE CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKINGHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28379-7349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-557-5490
Provider Business Practice Location Address Fax Number:
910-997-3777
Provider Enumeration Date:
01/04/2017