Provider First Line Business Practice Location Address:
1600 E 5TH 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:
28358-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-740-1701
Provider Business Practice Location Address Fax Number:
910-521-7827
Provider Enumeration Date:
08/05/2014