Provider First Line Business Practice Location Address:
1241 N ROAD ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-333-5519
Provider Business Practice Location Address Fax Number:
252-335-5365
Provider Enumeration Date:
01/10/2007