Provider First Line Business Practice Location Address:
806 W EHRINGHAUS 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:
27909-6935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-652-6115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2013