Provider First Line Business Practice Location Address:
1134 N ROAD ST STE 2
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:
27909-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-384-2770
Provider Business Practice Location Address Fax Number:
252-679-7673
Provider Enumeration Date:
12/28/2007