Provider First Line Business Practice Location Address:
300 W 27TH ST
Provider Second Line Business Practice Location Address:
SOUTHEASTERN MEDICAL CENTER
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-618-9807
Provider Business Practice Location Address Fax Number:
910-618-9216
Provider Enumeration Date:
05/10/2007