Provider First Line Business Practice Location Address: 
DUMC BOX 3443
    Provider Second Line Business Practice Location Address: 
DUKE UNIVERSITY MEDICAL CENTER
    Provider Business Practice Location Address City Name: 
DURHAM
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
27710-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
919-619-3052
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/14/2008