Provider First Line Business Practice Location Address:
508 E MAIN ST STE 201
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:
27909-4458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-338-5334
Provider Business Practice Location Address Fax Number:
252-338-1779
Provider Enumeration Date:
11/10/2009