Provider First Line Business Practice Location Address:
1 MEDICAL CTR BLVD
Provider Second Line Business Practice Location Address:
WFUBMC HOUSE STAFF OFFICE
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-6702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2010