Provider First Line Business Practice Location Address:
1134 N ROAD ST STE 6
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:
252-335-5128
Provider Business Practice Location Address Fax Number:
252-562-6704
Provider Enumeration Date:
03/16/2006