Provider First Line Business Practice Location Address:
204 E 5TH 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:
28358-5576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-272-8037
Provider Business Practice Location Address Fax Number:
910-272-8039
Provider Enumeration Date:
03/26/2007