Provider First Line Business Practice Location Address:
2601 N ELM ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358-3060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-738-7241
Provider Business Practice Location Address Fax Number:
910-738-6932
Provider Enumeration Date:
04/19/2006