Provider First Line Business Practice Location Address:
1241 B NORTH ROAD ST
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:
27909-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-5346
Provider Business Practice Location Address Fax Number:
252-335-5365
Provider Enumeration Date:
09/29/2008