Provider First Line Business Practice Location Address:
601 CARTHAGE RD
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:
28358-4526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-674-4184
Provider Business Practice Location Address Fax Number:
910-674-4184
Provider Enumeration Date:
03/21/2011