Provider First Line Business Practice Location Address:
113 W 8TH 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:
28358-4841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-272-5115
Provider Business Practice Location Address Fax Number:
910-272-5114
Provider Enumeration Date:
07/16/2010