Provider First Line Business Practice Location Address:
201 E ELIZABETH 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:
27909-4351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-621-2521
Provider Business Practice Location Address Fax Number:
252-458-2797
Provider Enumeration Date:
09/14/2018