Provider First Line Business Practice Location Address:
110 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-338-5183
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2008