Provider First Line Business Practice Location Address:
101 DAVITA LN
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:
27909-3314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-338-0151
Provider Business Practice Location Address Fax Number:
252-338-0567
Provider Enumeration Date:
11/17/2015