Provider First Line Business Practice Location Address:
207 S POINDEXTER ST
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:
27909-4834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-2901
Provider Business Practice Location Address Fax Number:
252-335-7425
Provider Enumeration Date:
09/20/2006