Graduated: 2016
NPI: 1578934576
Practice Locations (2)
4850 FAYETTEVILLE RD, SUITE C
LUMBERTON, NC 283582100
9107344787
COASTAL SOUTHEASTERN UNITED CARE LLC
3640 EXPRESS DR
SHALLOTTE, NC 284706501
9107555222
Source: CMS National Downloadable File, September 2026.