Provider First Line Business Practice Location Address:
210 NORTH FAYETTEVILLE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBER BRIDGE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-843-3414
Provider Business Practice Location Address Fax Number:
910-843-3540
Provider Enumeration Date:
12/18/2006