Provider First Line Business Practice Location Address:
3683 NC 211 HWY WEST
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:
28360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-739-0948
Provider Business Practice Location Address Fax Number:
910-738-6774
Provider Enumeration Date:
06/01/2006