Provider First Line Business Practice Location Address:
5025A OLD CLINIC
Provider Second Line Business Practice Location Address:
CAMPUS BOX 7550
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27599-7550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-843-4096
Provider Business Practice Location Address Fax Number:
919-962-9795
Provider Enumeration Date:
12/04/2007