Provider First Line Business Practice Location Address:
4145 FAYETTEVILLE RD STE C
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:
28358-2728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-738-1628
Provider Business Practice Location Address Fax Number:
910-671-4538
Provider Enumeration Date:
01/08/2007