Provider First Line Business Practice Location Address:
244 SMITH CHURCH RD
Provider Second Line Business Practice Location Address:
BLDG 5, MEDICAL PLAZA
Provider Business Practice Location Address City Name:
ROANOKE RAPIDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27870-4956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-535-1800
Provider Business Practice Location Address Fax Number:
252-535-3719
Provider Enumeration Date:
12/07/2005