Provider First Line Business Practice Location Address:
110 MEDICAL DR. SUITE 5
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-384-0388
Provider Business Practice Location Address Fax Number:
252-384-0188
Provider Enumeration Date:
04/26/2007