Provider First Line Business Practice Location Address:
1384 LIKHAW 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:
28358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-737-4004
Provider Business Practice Location Address Fax Number:
910-737-9650
Provider Enumeration Date:
02/22/2008