Provider First Line Business Practice Location Address:
528 JOHN HENRY LEE 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:
28358-9159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-272-0162
Provider Business Practice Location Address Fax Number:
910-272-0998
Provider Enumeration Date:
12/12/2006