Provider First Line Business Practice Location Address:
122 HARDING 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:
27909-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-331-2206
Provider Business Practice Location Address Fax Number:
252-331-1731
Provider Enumeration Date:
03/02/2017