Provider First Line Business Practice Location Address:
202 W HICKS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27932-1865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-482-7493
Provider Business Practice Location Address Fax Number:
252-482-5414
Provider Enumeration Date:
10/02/2006