Provider First Line Business Practice Location Address:
3317 NC HIGHWAY 211 W
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:
28360-3570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-608-6511
Provider Business Practice Location Address Fax Number:
910-608-3530
Provider Enumeration Date:
07/18/2008