Provider First Line Business Practice Location Address:
309 SELDEN 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:
27909-4661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-619-5299
Provider Business Practice Location Address Fax Number:
252-207-0450
Provider Enumeration Date:
03/02/2007