Provider First Line Business Practice Location Address:
1400 WEST CHURCH STREET EXT.
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:
27909-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-331-0322
Provider Business Practice Location Address Fax Number:
252-331-0320
Provider Enumeration Date:
06/04/2006