Provider First Line Business Practice Location Address:
915 W EHRINGHAUS ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-7042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-334-9624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2009