Provider First Line Business Practice Location Address:
175 KIMEL PARK DR
Provider Second Line Business Practice Location Address:
DBA WINSTON-SALEM HEALTHCARE
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-6951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-718-1006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2007