Provider First Line Business Practice Location Address:
504 E ELIZABETH STREET
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-384-0929
Provider Business Practice Location Address Fax Number:
252-384-0916
Provider Enumeration Date:
04/19/2006