Provider First Line Business Practice Location Address:
600 MT. MORIAH CHURCH ROAD
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:
910-738-7777
Provider Business Practice Location Address Fax Number:
910-738-9093
Provider Enumeration Date:
02/26/2007