Provider First Line Business Practice Location Address:
1177 NORTH ROAD STREET
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:
27909-4472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-338-9080
Provider Business Practice Location Address Fax Number:
252-338-6712
Provider Enumeration Date:
07/10/2010