Provider First Line Business Practice Location Address:
1507 N ROAD ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-333-1149
Provider Business Practice Location Address Fax Number:
252-338-6503
Provider Enumeration Date:
01/31/2008