Provider First Line Business Practice Location Address:
106 E 6TH 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:
28358-5509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-223-7114
Provider Business Practice Location Address Fax Number:
910-223-0098
Provider Enumeration Date:
09/15/2011