Provider First Line Business Practice Location Address:
1274 NC HIGHWAY 41 S
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:
28358-0215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-785-2667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2007