Provider First Line Business Practice Location Address:
500 W 27TH 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:
28358-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-618-0441
Provider Business Practice Location Address Fax Number:
910-738-3764
Provider Enumeration Date:
06/17/2009