Provider First Line Business Practice Location Address:
107E MOUNT MORIAH CHURCH ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-735-2873
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2010