Provider First Line Business Practice Location Address:
105 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
OBOT ROOM #100
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-333-1540
Provider Business Practice Location Address Fax Number:
252-333-1548
Provider Enumeration Date:
01/30/2023