Provider First Line Business Practice Location Address:
1910 WEEKSVILLE RD
Provider Second Line Business Practice Location Address:
STE 106 & 107
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-7988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-7814
Provider Business Practice Location Address Fax Number:
252-331-2762
Provider Enumeration Date:
07/04/2006