Provider First Line Business Practice Location Address:
113 E KING ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
EDENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27932-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-482-4436
Provider Business Practice Location Address Fax Number:
252-482-7903
Provider Enumeration Date:
02/09/2007