Provider First Line Business Practice Location Address:
1141 NORTH ROAD STREET
Provider Second Line Business Practice Location Address:
STE K
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-331-7600
Provider Business Practice Location Address Fax Number:
252-331-7730
Provider Enumeration Date:
07/14/2006