Provider First Line Business Practice Location Address:
2934 N ELM ST
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358-2986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-738-1182
Provider Business Practice Location Address Fax Number:
910-738-3764
Provider Enumeration Date:
07/31/2014