Provider First Line Business Practice Location Address:
1407 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:
28358-6007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-739-8622
Provider Business Practice Location Address Fax Number:
910-739-1180
Provider Enumeration Date:
06/02/2022