Provider First Line Business Practice Location Address:
4309 LUDGATE STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-738-2473
Provider Business Practice Location Address Fax Number:
910-739-6246
Provider Enumeration Date:
04/09/2007