Provider First Line Business Practice Location Address:
135 E RICH BLVD
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:
27909-5518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-333-1277
Provider Business Practice Location Address Fax Number:
252-333-1877
Provider Enumeration Date:
12/20/2007