Provider First Line Business Practice Location Address:
1309 E 5TH STR
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:
28358-6031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-739-1666
Provider Business Practice Location Address Fax Number:
910-739-6822
Provider Enumeration Date:
04/28/2006