Provider First Line Business Practice Location Address:
1301 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:
28358-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-738-6670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007