Provider First Line Business Practice Location Address:
222 VIRGINIA RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EDENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27932-9667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-482-2210
Provider Business Practice Location Address Fax Number:
252-482-2257
Provider Enumeration Date:
06/09/2006