Provider First Line Business Practice Location Address:
4908 BARKER TEN MILE RD
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:
28358-0137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-618-0445
Provider Business Practice Location Address Fax Number:
910-618-0455
Provider Enumeration Date:
06/12/2006