Provider First Line Business Practice Location Address:
304 W NC HIGHWAY 24
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28382-8684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-525-5848
Provider Business Practice Location Address Fax Number:
910-525-3838
Provider Enumeration Date:
07/11/2006