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:
252-335-2923
Provider Business Practice Location Address Fax Number:
252-335-7003
Provider Enumeration Date:
03/23/2006