Provider First Line Business Practice Location Address:
100 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358-5610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-671-8128
Provider Business Practice Location Address Fax Number:
910-671-8130
Provider Enumeration Date:
12/18/2007