Provider First Line Business Practice Location Address:
407 S GRIFFIN ST
Provider Second Line Business Practice Location Address:
STE J
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-4693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-338-1000
Provider Business Practice Location Address Fax Number:
252-338-1002
Provider Enumeration Date:
06/14/2013