Provider First Line Business Practice Location Address:
2934 NORTH ELM ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-735-8858
Provider Business Practice Location Address Fax Number:
910-735-8857
Provider Enumeration Date:
02/14/2012