Provider First Line Business Practice Location Address:
102 CASTLE COURT
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-9239
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007