Provider First Line Business Practice Location Address:
600 JACKSON ST
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:
27870-7161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-537-6164
Provider Business Practice Location Address Fax Number:
252-537-9199
Provider Enumeration Date:
04/19/2006