Provider First Line Business Practice Location Address:
1134 N ROAD ST
Provider Second Line Business Practice Location Address:
BLDG. 9
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-331-1100
Provider Business Practice Location Address Fax Number:
252-338-9170
Provider Enumeration Date:
07/29/2013