Provider First Line Business Practice Location Address:
409 E 2ND 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:
28358-5623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-608-2224
Provider Business Practice Location Address Fax Number:
910-608-2055
Provider Enumeration Date:
08/22/2006