Provider First Line Business Practice Location Address:
330 CAMDEN CSWY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-6811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-331-2437
Provider Business Practice Location Address Fax Number:
252-331-0308
Provider Enumeration Date:
02/12/2009