Provider First Line Business Practice Location Address:
100 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-9900
Provider Business Practice Location Address Fax Number:
252-335-9920
Provider Enumeration Date:
10/18/2005