Provider First Line Business Practice Location Address:
100 E KING ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EDENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27932-1956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-312-6670
Provider Business Practice Location Address Fax Number:
252-482-1770
Provider Enumeration Date:
12/19/2006