Provider First Line Business Practice Location Address:
400 SOUTH ROAD ST
Provider Second Line Business Practice Location Address:
SUITE D 1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-331-2388
Provider Business Practice Location Address Fax Number:
252-335-9969
Provider Enumeration Date:
05/10/2006