Provider First Line Business Practice Location Address:
800 MARTIN LUTHER KING JR DR
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:
28358-6412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-738-3957
Provider Business Practice Location Address Fax Number:
910-738-7354
Provider Enumeration Date:
08/18/2005