Provider First Line Business Practice Location Address:
1134 N ROAD ST
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-331-5869
Provider Business Practice Location Address Fax Number:
252-331-5906
Provider Enumeration Date:
11/08/2007