Provider First Line Business Practice Location Address:
1831 WEEKSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-7721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-872-1178
Provider Business Practice Location Address Fax Number:
919-872-1170
Provider Enumeration Date:
03/23/2012