Provider First Line Business Practice Location Address:
1076 US HIGHWAY 17 S
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:
27909-7627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-333-3111
Provider Business Practice Location Address Fax Number:
252-333-1105
Provider Enumeration Date:
04/22/2016